HomeMy WebLinkAbout06100071 Application
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City of Carmel! Clay Township i
APPLICATION FOR ELECTRICAL INSPECTION
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FAX I
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PHONE
NAME
CONTRACTOR
INFORMATION:
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Street Address
NAME
CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
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ZIP:
OR
Contractor
Representative
PROPERTY
OWNER
INFORMATION:
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,,- ',,' COMMERCIAl:
TYPE of WORK:
.'" RESIDENTIAL:".
PROPERTY OWNER NAME(S):
PHONE:
STREET AOORESS:
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State
INSPECTION
INFORMATION:
City
State
ZI'
PI
06077
'N
o UPGRADE SERVICE: From to
TIME OF INSPECTION:
~
M ING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
DATE OF INSPECTION: rJ
TYPE OF IMPROVEMENT:
rNO
Number of NEW CIRCUITS:
Number of METERS: 1-
o 'YES
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
J NEW METER SERVICE (i,e, Fountain in pond;
1\ Subdivision street or signage lighting; Installation of
new utility services for a n a rea)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006