HomeMy WebLinkAbout07010133 Application
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CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
01iJ (0/33
City of Carmel! Clay Township
APPLICA TION FOR ELECTRICAL INSPECTION
Street Address
LI/lNf
City
State
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C aY(}1f,
CONTACT PHONE:
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Property Owner
(or agent)
Contractor
Representative
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OR
RESIDENTIAL:
COMMERCIAL:
TYPE OF IMPROVEMENT.
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
to
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o UPGRADE SERVICE: From
DYES
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~W METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instaliation of
new utility services for an area)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON T S FORM IS COMPLETE AND ACCURATE.
L{(~Jii
PRINT
Ca%1-r1JY /111m
I DATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms{Electrical Application Apr 2006