HomeMy WebLinkAbout06100161 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
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PHONE
FAX
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Street Address
City
State
Zip
APPLICANT
INFORMATION: Property Owner
(or agent)
. . TYPE of WORK:-. ....- . . RESIDEN'11Al:--~-'"
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CONTACT PHONE:
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OR
Contractor
Representative ~
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PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
City
State
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CA
EL
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION tJ~
INFORMATION:
City
State
Zip I
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TIME OF INSPECTION:
DATE OF INSPECTION:
o UPGRADE PANEL BOARD(S)
~DmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRlBUJON SYSTEM
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? i
~ES 0 NO
Number of NEW CIRCUITS: :J."
Number of METERS: I
TYPE OF IMPROVEMENT:
~UPGRADESERVICE: From 1Ot/.4 to ;;{WA
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o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
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o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspection i $ 55.50 f r Residential Inspections
S:Permlts/Forms{Electrlcal Application Apr 2006
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