HomeMy WebLinkAbout07030160 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRIC!}L INSPECTION
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NAME
PHONE
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CONTRACTOR
INFORMATION:
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City .
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State Zip
Street Address
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APPLICANT
INFORMATION:
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Property Owner y"
(or agent) ~ OR
CONTACT PHONE:
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NAME
Contractor
Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL: X
PROPERTY
OWNER
INFORMATION:
PROPERTY OWNER NAME(S):
C I'VOi rJ ~d
PHONE:
STREET ADDRESS:
City
State
Zip
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STREET ADDRESS (INSPECTION LOCATION):
City
State
Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION:
'3
TIME OF INSPECTION:
o UPGRADE SERVICE: From to
1'l
MOVING SERVICE FROM OVERHEAD
TO: UNDERGROUND?
6 YES ~NO
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
NumberofMETERS:---L--
5
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECfRICAL DISTRIBUION SYSTEM
~
NEW METER SERVICE (Le. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THI FORM IS COMPLETE AND ACCURATE!
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DATE
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o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o CONNECTION orRECONNECTION TO A RELOCATED
STRUCfURE
PRINT
COMMENTS or FURTHER LOCATION CLA FICATION: (Please attach mao of insoection location)
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FEES: $ 100.00 for Commercial Inspections; $ 55.50 for Residential Inspections
S:Permlts/Forms/Electrlcal Application Apr 2006