HomeMy WebLinkAbout06110134 Application
City of Carmel/ Clay Township I
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION: Street Address
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City
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State
Zip
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NAME
CONTACT PHONE:
APPLICANT
INFORMATION:
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TYPE of WORK:
Property Owner ,/,\
(or agent) ~
RESIDENTIAL: f--
PROPERTY OWNER NAME(S):
OR
Contractor
Representative
COMMERCIAL:
PHONE:
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PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
City
State
Zip
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STREET ADDRESS (INSPECTION LOCATION):
City
State
Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION:
J-G\. TIME OF INSPECTION: :2 - t-(
MOVING SERVICE FROM OVERHEAD ~
TO UNDERGROUND? 33'1-
DYES )8J NO, ' 075"(
Number of NEW CIRCUITS: & )
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON~THIS F RM IS COMPLETE 'D ACCURATEff /
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Sign,., ,/ // I
11/IJ -It (A'la,-- //- 2'7-06
PRINT DATE
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From to
o UPGRADE PANEL BOARD(S)
,
p)ADDmON, ALTERATION, REMODEL, or REPAIR Tb
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM,
o 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)
o CONNECTION or RECONNECTlON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach ma of ins ection location)
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FEES: $ 100.00 for Commercial Inspection ; $ 55.50 fo Residential Inspections
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S:Permlts/Forms/Electrical Application Apr 2006