HomeMy WebLinkAbout07060113 Application
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City of Carmel/ Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME
PHONE
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City
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,
State lip
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CONTACT PHONE: l.L-t!L ~
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Contractor M L/c~'
Representative
CONTRACTOR
INFORMATION:
Street Address
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NAME
AP.PLICANT
INFORMATION:
{JEIUi CO_
Property Owner
(or agent) OR
TYPE of WORK:
RESIDENTIAL:
PROPERTY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
INSPECTION
INFORMATION:
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DATE OF INSPECTION:
~
TYPE OF IMPROVEMENT:
o UPGRADE SERVICE: From
to
o UPGRADE PANEL BOARD(S)
~ 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)
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMERCIAL: ~
PHONE:
State
,
Zip
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TIME OF INSPECTION:
MOVING SERVICE FROM. OVERHEAD
TO UNDERGROUND?
DYES
OiL NO
Number of NEW CIRCUITS:
Number of METERS: /
I CERTIFY THAT THE INFORMATION CONTAIIIJED
ON THIS FORM IS COMPLETE AND ACCURATE.
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Slgnatu
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PRlNT
DATE
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insoection location)
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FEES:
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$ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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S:Permlts/Forms/Electrical Appllcatlon Apr 2007
Survey Boundaries
- Township Lines
Transportation
Abc Interstate Hwy Text
Abc U.S. HwyText
Abc State HwyText
::ICII Interstate Highways
::lI::lI U.S. Highways
..... State Highways
= Primary Roads
~ Minor Roads
o Buildings
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Map1
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200
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600
http://www.co.hamilton.in.us/maps/county.mwf
Thursday, June 14, 2007 10:16 AM