HomeMy WebLinkAbout07110153 ApplicationOF CA
City of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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ME PHONE FAX
CONTRACTOR M
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INFORMATION: Street Address city State ZIP
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NAME CONTACT PHONE:
APPLICANT ?/ ?I
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INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: -zY COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
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OWNER
INFORMATION: STREETADDRESS: city state zip
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STREET ADDRESS (IN5PECTION LOCATION): City State Zip
INSPECTION
INFORMATION:
DATE OF INSPECTION: f/ aq 10 -7
TIME OF INSPECTION
TYPE OF IMPROVEMENT:
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
UPGRADE SERVICE: From 16:]2- to 20 y
O UPGRADE PANEL BOARD(S)
O ADDITION, 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
O YES )( NO
Number of NEW CIRCUITS: 7
Number of METERS:
I CER )-RAT THE INFORMATION CONTAINED
ON T "IS ORM IS COMPLETE AND ACCURATE.
ature
PRIM DATE
COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach may of inspection location)
I FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S:?ernits/For s/Electrlcal Application Apr 2007