HomeMy WebLinkAbout06110135 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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FAX I
317-~h,;z~ 7
State Zip I
X, cr&L 5 7.
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PHONE
CONTRACTOR
INFORMATION:
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Street Address
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NAME
CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
~P/><Z e (
OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: X
PROPERTY
OWNER
INFORMATION:
STREET ADDRESS:
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State
I
Zip I
PROPERTY OWNER NAME(S):
PHONE:
STREET ADDRESS (INSPECTION LOCATION):
City
State
Zip
INSPECTION
INFORMATION:
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DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
3
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
r;( NEW METER SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
Number of METERS:
/
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
DATE
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms{Electrtcal Application Apr 2006