HomeMy WebLinkAbout07040004 Application
City of Carmel/Clay Township 1t ~1D~6004.
APPLICATION FOR ELECTRICAL INSPECTION
CONTRACTOR
INFORMATION:
NAME
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PHONE FAX
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Street Address
CIty State
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CONTACT PHo~6 3-7I.\."S~
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NAME
APPLICANT
INFORMATION:
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Property Owner
(or agent)
Contractor
OR Representative
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
PROPERlY OWNER NAME(S):
PHONE:
PROPERTY
OWNER
INFORMATION:
S'7~Y17 ~ 2J
STREET ADDRESS:
Oty State
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INSPECTION
INFORMATION:
STREET ADDRESS (INSPEmON LOCATION): City
(~~..."- \ ~e ""1-w9-;",,-
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State
\. $.
MOVING SERVICE FROM
TO UNDERGROUND?
TYPE OF IMPR
_, ~ UPGRADE SERVICE: From \.00 to ::+DO
~ UPGRADE PANEL BOARD(S)
DYES
;g1J NO
Number of NEW CIRCUITS:
Number of METERS: ~
o ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DlSTRIBUION SYSTEM
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Zip j
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Zip
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I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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PRINT
o NEW METER SERVICE (i.e. 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)
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ATE
I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
FEES: $ 104.00 for Commercial Inspection
entia I Inspections
S:Permlts/FormsjElectrlcal Application Apr 2007