HomeMy WebLinkAbout07100074 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR CLEL°r` l?U4CEV?1€° j (.., j
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INFORMATION: Street Address city State Zip
NAME CONTACT PHONE:
APPLICANT - n
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INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY T321G+ [[?ouS? NE ?WOf2it 3(? 3j`? (`??{
OWNER
INFORMATION:
STREET ADDRESS:
City State
Zip
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STREET ADDRESS (INSPECTION LOCATION): City State zip
INSPECTION (-4
INFORMATION:
DATE OF INSPECTION:
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TIME OF INSPECTION:
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TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
? ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM
-k_NEW METER SERVICE (i.e. Fountain in pond;
Subdivision street or signage lighting; Installation of
new utility services for an area)
? ROW SIGNAL, SENSOR, MONITOR (i.e. Traffic Light)
? CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
O YES O NO
Number of NEW CIRCUITS: I?
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I CERTIFY THAT THE INFORMATION
ON THIS FORM IS COMPLEN AND A
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Signature
PRINT
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
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S:Pennlts/Forms,!Electdcal Application Apr 2007
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections