HomeMy WebLinkAbout07050140 Application
City of Carmel/ Oay Township
APPLICATION FOR ELECTRICAL INSPECTION:
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PHONE
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INFORMATION: '
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NAME
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CONTACT PHONE:
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APPUCANT
INFORMATION:
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Property Owner
(or agent)
OR
Contractor
Representative
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X
TYPE of WORK:
RESIDENTIAL:
COMMERCIAL:
PROPERTY OWNERNAME(S):
PHONE:
PROPERJY .
OWr-.lER. . .
INFORMAtiON:
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5TREEr ADDREss:
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State
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STREET ADORESS (INSPECTION LOCATION):
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Zip
State
Zip
INSPECT!QN
INFORMAtiON:"
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DATE OF INSPECT10N:
TIME OF INSPECT10N:
TYPEOFIMPROVEMENl':
- . . .
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
o UPGRADEPANEL'BOARD(S)
o ADDrirJ:ON, ALTERATION, REMODEL, or REPAIRTO
AN:,EXISTING ELECTRICAL DISTRIBUION SYSTEM
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to
o YES
~'NO
)(.
- .' .
._, ".-."
'- .'.- .'
NEvyMPI~RSE~\IICE (i,e. Fountain in pond;
Subdiyisionst:J"~t or signage lighting; Installation of
newutilityiserVlces for an area)
I CERTIFY THAT THE INFORMATION CONTAIN D
ON THIS FORM IS COMPLETE ND AC RATE
o ROW SIGNAL, SENSOR, MONITOR (Le. Traffic Light)
o 'CONNECT10N'or RECONNECT10N TO A RELOCATED
STRUCnJRE
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PRINT
oLNJo
ATE
COMMENTS or FURTHERLOCA TION' CLARIFICATION: (Please attach maD of insDecuon iocation )
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fEES: $ 1()4;OO.for Commercial Inspections; $S7 .SOfar ResidEmtialIns<pections