HomeMy WebLinkAbout07060004 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX I
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CONTRACTOR
INFORMATION:
APPLICANT
INFORMATION:
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
E
STREET ADDRESS:
3'&00 e. q/" ~ wed
STREET ADDRESS (INSPECTION LOCATION):
INSPECTION 3 ';? (J c- r;; #
INFORMATION:
DATE OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From to
o UPGRADE PANEL BOARD(S)
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
i1I NEW METER SERVICE (i.e. Fountain in pond;
I \ 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
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TN 4-<00 ltJO ZI1
CONTACT PHONE:
.3 n) 'l13~ 11'f3
OR
Contractor
Representative J(
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,
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COMMERCIAL: X
PHONE:
City
TrJio.",c.
State
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Zip
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TN
City
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State
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO N A
,
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Number of NEW CIRCUITS:
Number of METERS:
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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CP.:jJ'1 s, S'-kck;
PRINT
G;; /0:'7
DATE !
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection lociltion)
I+ is dl,{e ~Ou+h. c~ ScJ\Clf?2er COo..tl:JS, (Please.
co"'l Aa.(oY\ oJ 11~~q(04). w;"\-h f.l€s-hoY\s.)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:PermltsjForms/Electrlcal Application Apr 2007