Forms

Residential Electrical Permit Application

Today's Date * Required
Job Address * Required
Permit No.
Owner Name * Required
Owner Address * Required
Description of work
General Lighting Number * Required
Sq. ft.x2÷120÷15=no. of general lighting circuits
General Lighting Fee * Required
General Lighting Total * Required
(Number x Fee) (automatically calculated)
Kitchen Number * Required
At least 2 20amp each
Kitchen Fee * Required
Kitchen Total * Required
(Number x Fee) (automatically calculated)
Refrigerator (15 amp) Number
Refrigerator (15 amp) Fee
Refrigerator (15 amp) Total * Required
(Number x Fee) (automatically calculated)
Laundry (1 each) Number
Laundry (1 each) Fee
Laundry (1 each) Total * Required
(Number x Fee) (automatically calculated)
Furnace (gas or electric) Number
Furnace (gas or electric) Fee
Furnace (gas or electric) Total * Required
(Number x Fee) (automatically calculated)
Smoke Alarms Number
Need to be on separate circuit with battery backup
Smoke Alarms Fee
Smoke Alarms Total * Required
(Number x Fee) (automatically calculated)
Bathrooms Number
Need separate circuit for GFCI’s
Bathrooms Fee
Bathrooms Total * Required
(Number x Fee) (automatically calculated)
Enter Number of each Fixed Electrical Appliances
Range Dryer A/C Water Heater Other
Totals
Total Fees * Required
(automatically calculated)
Signature of Applicant * Required
Company Name * Required
Company Address * Required
Inspector
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