HomeMy WebLinkAbout08010081 ApplicationCity of Carmel/Clay Township -v1-cVloogl
APPLICATION FOR ELECTRICAL INSPECTION
NAME PHONE FAX
CONTRACTOR ?a'4.1J
INFORMATION: Street Address City State Zip
NAME CONTACT PHONE:
APPLICANT , L , % /
INFORMATION: prope er Contractor
(or agent) OR Representative
TYPE of WORK: RESIDENTIAL: COMMERCIAL:
PROPERTY OWNER NAME(S): PHONE:
PROPERTY Tt
OWNER
INFORMATION: STREET ADDRESS: city state Zip
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STREET ADDRESS (INSPECTION LOCATION): city state ZIP
INSPECTION .
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INFORMATION:
OF INSPECTIO TIME OF INSPECTION:
TYPE OF IMPRO
O UPGRADE SERVICE: From to
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
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.
Signature
PRINT DATE
COMMENTS oyfURTHER LOCATION CLARIFICATION: (Please attach map of inspection location)
FEE : $ 104.00 for Commercial inspections; $ 57.50 for Residential Inspections
Application Apr 2007