HomeMy WebLinkAbout06110045 Application
City of Carmel! Clay Township i
APPLICATION FOs,.ELECTRICAL INSPECTION
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o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
~ CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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NAME
CONTRACTOR
INFORMATION: Street Address
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NAME
APPLICANT
INFORMATION:
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Property Owner
(or agent)
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TYPE of WORK:
. ." RESIDENTIAL:"
PROPERTI OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
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STREET ADDRESS (INSPEC110N LOCATION):
INSPECTION
INFORMATION:
DATE OF INSPECTION:
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TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instailation of
new utility services for an area)
PHONE
FAX
aty State
Zip
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CONTACT PHONE:
OR
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Contractor h-
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Representative
Dty
COMMERGIA~: ~.,
PHONE: C ,.~71r~r ~p~,/
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City
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State
Zip
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TIME OF INSPECTION:
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS: I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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Signature. -
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PRINT
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o~TE
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:PermltsjForms/Electrlcal Application Apr 2006