HomeMy WebLinkAbout07040176 Application
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
CONTRACTOR :Yuw-l
INFORMATION: Street Address
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NAME
APPLICANT ~
INFORMATION: Property Owner /.
(or agent)
TYPE of WORK: RESIDENTIAL: V
PROPERTY OWNER NAME(S):
PROPERTY ~
OWNER
INFORMATION: STREET ADDRESS:
PHONE
FAX
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City
State
Zip
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CONTACT PHONE:
Contractor
OR Representative
COMMERCIAL:
PHONE:
City
State
Zip
INSPECTION
INFORMATION:
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MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND? I
STREET ADDRESS (INSPECITON LOCATION):
City
State
Zip
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
~ UPGRADE SERVICE: From // 0 to 26 0
rrI UPGRADE PANEL BOARD(S)
DYES
o NO
Number of NEW CIRCUITS:
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Number of METERS:
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURAT~.
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)
Signature
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
-St-rei I k 1:>. GreLl) n+ t-
PRINT
M/zS/J 1
DATE
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PermltsjForms/Electrical Application Apr 2007