Action Center / PERMITS - Electrical Permit Application / Sulphur, Louisiana

ELECTRICAL PERMIT APPLICATION

Date of Application*

MonthDay Year,

Owner Information

Owner Name*

Owner's Physical Address*

Owner Email Address*

Confirm Owner Email Address*

Please Do Not Complete The Following Field

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-Phone 3-Phone 4 ext Extension

Contractor Mobile Phone Number

Phone Area Code-Phone 3-Phone 4 ext Extension

Job Information

Type of Job*

Physical Address of Job*

Description*

Electrical Type Request*

If you selected Other for Service Type Request - Please Explain

Number of Circuits & $15.00 Inspection Fee

# of Single Pole Breakers ($2.00 ea)

# 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-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.

PERMITS - Electrical Permit Application

PERMITS - Electrical Permit Application

ELECTRICAL PERMIT APPLICATION

Owner Information

Contractor Information

Job Information

Number of Circuits & $15.00 Inspection Fee

Fees

Disclaimers

FOR OFFICE USE ONLY

ENTERED BY: __ DATE: _

PERMIT #: _____ FLOOD ZONE: _ INSPECTOR: ______

Dialog Title

PERMITS - Electrical Permit Application

PERMITS - Electrical Permit Application

ELECTRICAL PERMIT APPLICATION

Owner Information

Contractor Information

Job Information

Number of Circuits & $15.00 Inspection Fee

Fees

Disclaimers

FOR OFFICE USE ONLY

ENTERED BY: ______________________________ DATE: _____________________________

PERMIT #: ___________ FLOOD ZONE: _____________ INSPECTOR: ____________

Dialog Title

ENTERED BY: __ DATE: _

PERMIT #: _____ FLOOD ZONE: _ INSPECTOR: ______