HomeMy WebLinkAbout07020043 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
FAX
CONTRACTOR
INFORMATION: SlreetAddress
City
State
Zip
CONTAcr PHONE:
APPLICANT
INFORMATION:
Owner
(or agent) OR
RESIDENTIAL: 1/
Contractor
Representative
TYPE of WORK:
COMMERCIAL:
PROPERTY
OWNER
INFORMATION: /
PHONE:
STREET ADDRESS:
City
State
Zip
City
State
Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
~GRADE SERVICE: From )1-<:> toU-$
~GRADE PANEL BOARD(S)
~DmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
~NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
n"cta
OVING SERVICE FROM OVERHEAD
TO UNDERGROUND? ~
o YES ~ NO
Number of NEW CIRCUITS: /
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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PRINT DATE
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
CO~TS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 100.00 for Commercial Inspections
55.50 for Residential Ins ections
5: PermIts/Forms/Electrical Appllcatlon Apr 2006