HomeMy WebLinkAbout06100076 Application
City of Carmel! Clay Township ff 00/0007 P
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
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PHONE
FAX
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City
State Zip
APPLICANT
INFORMATION:
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PROPERTY
OWNER
INFORMATION:
PHONE:
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,,_. TYPE of WORK:..,.. -.' '-'"RESIDENTIAL:'''
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State
Zip
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State Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
o UPGRADE SERVICE: From
to
,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
~ES
o NO
TYPE OF IMPROVEMENT:
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
:
Number of NEW CIRCUITS: p-CJ
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Number of METERS: -----?-- !
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I CERTIFY THAT THE INFORMATIO CONTAINED
o IS OMPLETE AN CCURATE.
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Signature " I
f)A-r/11J /fSIf'/~ Cl0/1 /0-/0.-06
PRINT .. OATE I
(Please attach maD of insDection 10c~tiOn)
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o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
,
I
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts{Forms/Electrical Application Apr 2006