HomeMy WebLinkAbout07120004 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
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CONTRACTOR BO
INFORMATION: Street Address clrj state Zip
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NAME CONTACT PHONE:
APPLICANT f I
INFORMATION: Property Owner Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: ICJ COMMERCIAL:
PROPERTY O1VNER NAME(S): PHONE:
PROPERTY Q
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OWNER
INFORMATION: STREET ADDRESS: city sate Zip
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STREET ADDRESS (INSPE ON OCATION): City State Zip
INSPECTION /DW )Z ((
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INFORMATION:
DATE OF INSPECTIO TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
O UPGRADE PANEL BOARD(S)
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
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES NO
Number of NEW CIRCUITS:
Number of METERS: -
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
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COMMENTS or FURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
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S:Pe,nWForrrslElectrl;al Appllcatlon. Aar 2007