HomeMy WebLinkAbout07010102 Application
CONTRACTOR
INFORMATION:
City of Carmel! Clay Township !) 1 0 ( () / IJ ~
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APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
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Street Ad dress
City
State
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NAME
CONTACT PHONE:
APPLICANT "3:r:. V'"^-
INFORMATION: Property Owner
(or agent)
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OR
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Contractor /'
Representative ~
TYPE of WORK:
RESIDENTIAL:
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COMMERCIAL:
PROPERTY OWNER NAME(S):
PHONE:
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City I
State Zip
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City State Zip
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
STREET ADDRESS (INSPEcnON LOCATION):
INSPECTION
INFORMATION:
DATE OF INSPEcnON:
TIME OF INSPECTION: /'fJ
MOVING SERVICE FROM VERHEAD
TO UNDERGROUND?
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
DYES
o NO
o UPGRADE PANEL BOARD(S)
'if ADDmON, ALTERATION, REMODEL, or REPAIR TO
r AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of NEW CIRCUITS:
Number of METERS:
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utiiity services for an area)
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,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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Oittl1~ Pl?~ /-Iq-ch
PRINT DATE I
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNEcnON or RECONNEcnON TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 100.00 for Commercial Inspections; $' 55.50 :'or Residential Inspections
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S:Permlts/Forms/Electrlcal Application Apr 200,