HomeMy WebLinkAbout06100180 Application
CONTRACTOR
INFORMATION:
City of Carmel/ Clay Township =If i 6 / IJ tJ / ~
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
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NAME
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Zip
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CONTAcrPHONE: ~;.....~a- l
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Contractor " ., e- JM6~L. I
Representative 11'7-;t/",--://;J3',
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Street Address
City
State
APPLICANT
INFORMATION:
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Property Owner
(or agent) S I"> e
OR
TYPE of WORK:
.. RESIDENTIAL: .
,..~ ".,-,' COMMERCIAl:
PHONE:
City State Zip
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City $tate Zip
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
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STREET ADDRESS (INSPECTION LOCATION):
INSPECTION
INFORMATION:
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TIME OF INSPECTION:
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,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
sk NO
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o UPGRADE SERVICE: From
to
DYES
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: I
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
19ft f
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c 0 ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
NEW METER SERVICE (f.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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Signature '
PRlrf,C-he;r/' (',/?, 77 ~-6~
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006