HomeMy WebLinkAbout07060013 Application
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City of Carmel! Clay Township {J .
APPLICATION FOR ELECTRICAL IN.Sf CT!C.;Ji
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NAME
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CONTRACTOR
INFORMATION:
PHONE
FAX
P72
City
State
Zip
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NAME
APPLICANT
INFORMATION:
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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 (INSPEmoN LOCATION):
INSPECTION ~
INFORMATION:'
OR
Contractor
Representative
COMMERCIAL:
PHONE:
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Oty
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State
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State
Zip'
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DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
~ON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
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)
o CONNECTION orRECONNECTIONTO A RELOCATED
STRUCTURE
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
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Number of NEW CIRCUITS:
Number of METERS:
I CERTIFY THAT THE INFORMATION. CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE. I
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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I FEES: $ 104.00 for Commercial Inspectio~; $ 57.50 for Residential Inspections
S:PermltsjForms/Electrlcal Appllcatlon.Apr 2007 ~ ~