HomeMy WebLinkAbout06110023 Application
City of Carmel/Clay Township 1~:tf: ()~ floe 23.
APPLICATION FOR ELECTRICAL INSPECTION
I
NAME
PHONE
FAX
CONTRACTOR
INFORMATION:
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CIty State
Zip
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CONTACT PHONE:
APPLICANT
INFORMATION:
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Property Owner N
(or agent) .::.t::::-
OR
Contractor ~ I
Representative ~
. TYPE of WORK:'" '" ,> ": ..' RESIDENTIAL:" " '"
COMMERCIAL:....)( .
.;.
PROPERTY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
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State
Zip
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STREIT ADDRESS (INSP
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DATE OF INSPECTION: / C;S
TYPE OF IMPROVEMENT:
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City
State
Zip
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MOVING SERVICE FROM OVER
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS: ~
Number of METERS: ~ :
I
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THI R COMPLETE AND AC TE.I
.
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
)J NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
re
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT -
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ATE
COMMENTS or FURTH R LOCATION CLA FICA
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006