HomeMy WebLinkAbout07080062 Application
City of Carmel! Clay Township
APPLICATION FOR ELECTRICAL INSPECTIONl
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CONTRACTOR
INFORMATION:
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Street Address
APPLICANT
INFORMATION:
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Property Owner
(or agent)
TYPE of WORK:
-----
RESIDENTIAL:
PROPER1Y OWNER NAME(S):
PROPERTY
OWNER
INFORMATION:
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STREET ADDRESS:
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INSPECTION
INFORMATION:
o
TYPE OF IMPROVEMENT~ ~ s ~~
~ UPGRADE SERVICE: From '-. to ~ '- ~oO)
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)
PHONE
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Zip!
City
State
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CONTACT PHONE:
OR
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Contractor
Representative
COMMERCIAL:
PHONE:
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City State Zip I
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City State Zip I
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TIME OF INSPECTION:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
DYES
o NO
Number of NEW CIRCUITS:
Number of METERS:
. ,
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE,
~a--: ~4 dr
Signa,",. ( /f-V ~ 4 ' /" er
PRINT DATE
o ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
o CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach maD of insDection location)
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspectihns
S:Permlts/FormsjEfectrlcal Application Apr 2007