HomeMy WebLinkAbout07060129 Application
CONTRACTOR
INFORMATION:
City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
&'7C?b () /~/ I
~6~-,U5b
lip
T) b
PHONE
2
City
State
NAME
CONTACT PHONE:
APPLICANT l r.
INFORMATION: Property Owner
(or agent)
PROPERlY OWNER NAME(S):
Contractor 4-
OR Representative
COMMERGAL:
PHONE:
City State Zip
(( D L/. J
City State Zip
TYPE of WORK: RESIDENTIAL:
PROPERTY
OWNER
INFORMATION:
INSPECTION ~l1
INFORMATION:
DATE OF INSPECTION:
/r~/"C6.
~'
TIME OF INSPECTION:
o UPGRADE SERVICE: From to
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
!<' YES 0 NO
Number of NEW CIRCUITS:
Number of METERS: J
TYPE OF IMPROVEMENT:
o UPGRADE PANEL BOARD(S)
o ADDmON, 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)
/ (~iJ (7 <;
PRINT .--
o ROW SIGNAL, SENSOR, MONITOR (Le, Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
, r: + fJ P'
\ I
//C/P! '\L-
~J
1
FEES: $ 104.00 for Commercial Inspectionsi$ 57.50 for Residential Inspections
S:Pennlts/Forms/Electrlcal Appllcation;'Apr 2007