HomeMy WebLinkAbout06120074 Application
City of Carmel/Clay Township Ov / 2./J!J 1 'I
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR
INFORMATION:
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Street Address
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NAME
APPLICANT
INFORMATION:
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Property Owner
(or agent)
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PHONE
FAX
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State
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CONTACT PHONE:
OR
Contractor
Representative
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.-- -TYPE of WORK:--. '-' - .... RESIDENl'lA~:"
--. - --- --- - - -.. -COMMERCIAL:~'-'-
PROPERlY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
/217 vV- /?U j-t/-ur
STREET ADDRESS (INSPEcnON LOCATION):
INSPECTION
INFORMATION:
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o
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; Installation of
new utility services for an area)
PHONE:
City
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City
State
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State
Zip
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TIME OF INSPECTION:
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
W NO
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Number of NEW CIRCUITS: 0:
,
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND CCURATE'.
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o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
~ CONNECTION or RECONNECTION TO A RELOCATED
, STRUCTURE _
IS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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Signature
&,
PRINT
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts{Forms/Electrlcal ApplicatIon Apr 2006