HomeMy WebLinkAbout07010107 Application
City of Carmel! Clay Township tJ 1 61 () / ()?
APPLICATION FOR ELECTRICAL INSPECTION
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CONTRACTOR
INFORMATION:
NAMEC I
Elec:h-. .
Street Address
NAME
APPLICANT
INFORMATION:
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Property Owner
(or agent)
TYPE of WORK:
RESIDENTIAL:
PROPERT'I OWNER NAME(S):
PHONE
FAX
317-~o'l~S
:3/7-$1-'5'8/1
City
State Zip
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CONTACT PHONE:
OR
Contractor
Representative
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COMMERCIAL: ~
PHONE: '!l .......... C 1/(;' tJ
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PROPERTY
OWNER
INFORMATION:
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City f7
(Yl~i'J,'wvI fjt Wr>1~1
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DATE I
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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STREET AD ESS:
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~ METER SERVICE (Le, 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 RECONNECTION TO A RELOCATED
STRUCTURE
State
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HI
Zip
City
State
Zip
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TIME OF INSPECTION:
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,
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? :
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DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
I ERTIFY THAT THE INFORMATION CONTAINED
NT R E AND ACCURATE.
PRINT
'FEES: $ 100,00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006