HomeMy WebLinkAbout07070061 Application
City of Carmel/ Clay Township I
APPLICATION FOR ELECTRICAL INSPECTION cAf.'
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NAME PHONE FAX I
CONTRACTOR
INFORMATION:
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APPLICANT
INFORMATION:
City
State
Zip
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CONTACT PHONE:
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Property Owner
(or agent)
OR
Contractor
Representative
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TYPE of WORK:
RESIDENTIAL: COMMERCIAL: ~.
PROPERTY OWNER NAME(S): (~Jt1) '115" -O'i5C( . PHONE: .:J'Y'lP(~M"t..151 IN,
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PROPERTY
OWNER
INFORMATION'
City
State
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7-10,.):; VI LL-C
City.
INSPECTION
INFORMATION:
TYPE OF IMPROVEMENT:
,
. MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
o UPGRADE SERVICE: From
to
DYES
(0'.' NO
o UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS: 3 I
Number of METERS: I
o ADDmON, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
Er NEW MffiR SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Instaliation of
new utility services for an area)
,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS ORM IS COMPLffi AND ACCURATE.
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
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PRINT ~ DATE
LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:Permlts{Forms/Electrlcal Application Apr 2007
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