HomeMy WebLinkAbout06110022 Application
City of Carmel/Clay Townshipr~t(JGIIO o;Z~
APPLICATION FOR ELECTRICAL INSPECTION
NAME
PHONE i,\l-
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Zip
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CONTRACTOR
INFORMATION:
City State
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CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
~
Contractor .
OR Representative
TYPE of WORK:" ...........RESIDENTIAl:
. '. .-. .-. ... EOMMERCIAL: ..
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PROPERIT OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION: .
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State Zip
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State Zip
INSPECTION
INFORMATION:
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TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OV
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
Number of METERS: ~
~
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ NEW METER SERVICE (Le.Fountain in pond;
Subdivision street or signage lighting; Instailation of
new utility services for an area)
I
I
,
E INFORMATION CONTAINED
COMPLETE AND AC RATE. I
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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PRINT
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DATE
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/FormS/Electrlcal Application Apr 2006