HomeMy WebLinkAbout07030042 Application
City of Carmel/ Clay Township '-l/i!;? M
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR /
INFORMATION: Street Address
- APPLICANT '7
INFORMATION:
TYPE of WORK:
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
RESIDENTIAL: ~
PROPER1Y OWNER NAME(S):
C{.
STREET ADDRESS:
PHONE FAX
City State Zip
CONTACT PHONE: 31'1- 0757
Contractor ~
OR Representative
COMMERCIAL:
PHONE:
City State Zip
'-
L3cv.
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
~DmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage iighting; 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
COMMENTS or FURTHER LOCATION CLARIFICATION:
~d/
./
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
rn/NO
Number of NEW CIRCUITS: 0 I
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE. '
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Signature .
7.-
PRINT
FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts{FormS/Electrical Application Apr 2006