HomeMy WebLinkAbout07070010 Application
City of CarmelA@lay Township ~ 0107 DO 10
APPLICATION FOR ELECTRICAL INSPECTION
NAME
CONTRACTOR
INFORMATION:
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Street Address
PHONE
FAX
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Zip
State
NAME
CONTACT PHONE:
APPLICANT
INFORMATION: Property Owner
(or agent)
TYPE of WORK: RESIDENTIAL:
PROPERlY OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS (INSPECT10N LOCATION):
INSPECTION
INFORMATION:
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
)(
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
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OR
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Contractor
Representative L
COMMERCIAL: X
PHONE:
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Zip
State
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Zip
TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
i)( NO
Number of NEW CIRCUITS:
Number of METERS: j...
Signature
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PRINT
+/Z/07-
DATE I
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDectfon location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections