HomeMy WebLinkAbout08010022 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME PHONE FAX
CONTRACTOR e .317 s?>> 5i 7 J ---
INFORMATION: street Address atv state Zip
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NAME CONTACT PHONE:
APPLICANT rr- Z- - r ?' • 7i
INFORMATION: Property Owner Contractor
(or agent) OR Representative -e Gdt
TYPE of WORK: RESIDENTIAL: COMMERCIAL: _
PROPERTY OWNER NAME(S): PHONE:
PROPERTY
OWNER T T
INFORMATION: STREET ADDRESS: City state ZIP
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STREET ADDRESS (INSPECTION LOCATION): City state Zip
INSPECTION
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IN
ORMATION:
DATE OF INSPECTION: TIME OF INSPECTION:
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TYPE OF IMPROVEMENT: MOVING SERVICE FROM OVERHEAD
D a TO UNDERGROUND?
O UPGRADE SERVICE: From YES NO
JAN 10 200
O UPGRADE PANEL BOARD(S)
Number of NEW CIRCUITS:
O ADDITION, ALTERATION, REMOD ,
AN EXISTING ELECTRICAL DISTRIBUION SYSTEM Number of METERS:
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)
CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FORM IS COMPLETE AND ACCURATE.
ell,
PRINT DATE
COMMENTS or FURTHER
;LOCATION CLARIFICATION: (Please attach map of inspection location)
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FEES: `$ 44.e"or Commercial Inspections; $ 57.50 for Residential Inspections
S:Perm!ts/FormsVElectrical Application Apr 2007