HomeMy WebLinkAbout07050063 Application
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
O~0063
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CONTRACTOR
INFORMATION:
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NAME
APPUCANT
INFORMATION:
Property Owner
(or agent)
TYPE of WORK:
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RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
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STREET ADDRESS {lNSPEffiON LOCATION}:
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
oJ UPGRADE SERVICE: Fromo<'OO to '100
01 UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
o NEW MffiR 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)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
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PHONE 3
FAX
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City
State
Zip
cj606&-
1
CONTACT PHONE:
OR
Contractor
Representative
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. > J..,...J :735
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COMMERCIAL:
PHONE:
311--
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State Zip
IN q603?
City
State
lip
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
~YES 0 NO
Number of NEW CIRCUITS:
Number of METERS: -1--
I CERTIFY THAT THE INFORMATION CONTAINED
ON TH FORM IS COMPLETE AN ACCURATE.
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PRINT
05'-07-0
DATE
(Please attach maD of insDection location)
FEES: $ 100.00 ($104.00 after 4/2/07) for Commercial;
5: Permits/Forms/Electrical Application Apr 2006
.50 ($57.50 after 4/2/07) for Residential.
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