HomeMy WebLinkAbout08020016 ApplicationCity of Carmel/Clay Township
APPLICATION FOR ELECTRICAL INSPECTION
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NAME _ -
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CONTRACTOR
INFORMATION: streetAd&ess State ZIP
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APPLICANT
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? _2002
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INFORMATION: rope Contractor
or agent) OR Representative
TYPE of WORK: RESIDENTIAL:- COMMERCIAL:
PROPERTY PROPERTY OWNER QNAME( S):
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OWNER
INFORMATION: STREETADDRE55:
:?, -7 13 3 7,/- 5--, city State ZIP
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STREET ADDRESS (INSPECTION LOCATION): CRY State zjP
INSPECTION
INFORMATION:
DATE OF INSPECTION:
TIME OF INSPECTION:
TYPE OF IMPROVEMENT:
O UPGRADE SERVICE: From to
UPGRADE PANEL BOARD(S)
O ADDITION, ALTERATION, REMODEL, or REPAIR TO
AN EKSTING ELECTRICAL DISTRIBUION SYSTEM
MOVING SERVICE FROM OVERHEAD
TO UNDERGROUND?
O YES Z ISO
Number of NEW CIRCUITS:
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)
O CONNECTION or RECONNECTION TO A RELOCATED
STRUCTURE
COMMENTS or FURTHER LOCATION CLARIFICATION:
I
I CERTIFY THAT THE INFORMATION CONTAINED
ON THIS FE9SMLIS COMPLETE AND ACCURATE.
.-,144
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FEES: $ 104.00 for Commercial Inspections; $ 57.50 for Residential Inspections
S: Perm1ts/F0M%S/EIeGAc31 Appkavw Apr 2007