The City of Sulphur, Louisiana
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PERMITS - Electrical Permit Application
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PERMITS - Electrical Permit Application
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Denotes a required field
ELECTRICAL PERMIT APPLICATION
Date of Application
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Year
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Owner Information
Owner Name
*
Owner's Physical Address
*
Owner Email Address
*
Confirm Owner Email Address
*
Owner Phone Number
*
Phone Area Code
-
Phone 3
-
Phone 4
ext
Extension
Owner's Entergy Account Number
Contractor Information
Contractor Name
*
Contractor's Physical Address
*
Contractor Email Address
*
Confirm Contractor Email Address
*
Contractor Office Phone Number
*
Phone Area Code
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Phone 3
-
Phone 4
ext
Extension
Contractor Mobile Phone Number
Phone Area Code
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Phone 3
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Phone 4
ext
Extension
Job Information
Type of Job
*
Residential
Commercial
Physical Address of Job
*
Description
*
Electrical Type Request
*
Service Change
New Service
Temp Pole
Reset Meter
Other (Please Explain Below)
If you selected Other for Service Type Request - Please Explain
Number of Circuits & $15.00 Inspection Fee
# of Single Pole Breakers ($2.00 ea)
Please Do Not Complete The Following Field
# of Double Pole Breakers ($4.00 ea)
# of Triple Pole Breakers ($6.00 ea)
# of Mains ($4.00 ea)
# of Mains Three Phase ($6.00 ea)
Fees
Phone number of person paying fees
*
Phone Area Code
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Phone 3
-
Phone 4
ext
Extension
Email of person paying fees & receiving application confirmation
*
Confirm Email of person paying fees & receiving application confirmation
*
Disclaimers
I agree to the disclaimers.
*
Yes
All specified electrical wiring is to be done by the undersigned licensed and bonded Electrician with the City of Sulphur, and all work shall conform to the National Electrical Codes, which is enforced by the City of Sulphur inspectors. According to Ordinance No. 5-41, the City of Sulphur shall not be liable or held responsible for any damages to any person injured by any defect in any construction, wiring, or by installation thereof; nor shall the City of Sulphur or any official or employee thereof be held as assuming any such liability or responsibility by reason of any inspection authorized hereunder or certificate of approval issued by the inspector.
TERMINATION OF PERMIT BY OWNER. In the event of termination or cancellation of a permit by an owner, the owner must notify the City in writing of said termination and notify the City if the name of the substitute or replacement contractor, if any. The permit shall be amended effective on the date of notice of the substitute or replacement contractor form from the owner. The owner shall pay the sum of $50.00 for the substitution and/or replacement of a contractor.
FOR OFFICE USE ONLY
ENTERED BY: ______________________________ DATE: _____________________________
PERMIT #: ___________ FLOOD ZONE: _____________ INSPECTOR: ____________
