HomeMy WebLinkAbout06120104 Application
CONTRACTOR
INFORMATION:
City of Carmel/ Clay Township ,
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APPLICATION FOR ELECTRICAL INSPECTION
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PHONE Cc/l (Ji7) 710 -7 r7Ftv:
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NAME
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APPLICANT
INFORMATION:
Street Address
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NAME .j ~ ") <:,i: (4,) pe r-
Property Owner
(or agent) nt.-J lieF
Oty
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State
Zip
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CONTACT PHONE:
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OR
Contractor
Representative
TYPE of WORK:
RESIDENTIAL: V-
COMMERCIAL:
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
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PHONE:
B4~-]OOJ
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oty
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State
Zip
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STREET ADDRESS:
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STREET ADDRESS (INSPECTlON LOCATION):
City
State
Zip I
DATE OF INSPECTION:
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TIME OF INSPECTION:~.' }p- 1/1 ;a
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
INSPECTION
INFORMATION:
TYPE OF IMPROVEMENT:
~GRADE SERVICE: From //::10 to .;}b~
v-1JPGRADE PANEL BOARD(S)
DYES
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Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE. I
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o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
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Signature
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT ' DATE
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspection ;$ 5~50 for R idential Inspections
S:Permlts/FormsjElectrical Application Apr 2006