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

Owner Phone Number

Owner Phone Number Area Code-Owner Phone Number Prefix-Owner Phone Number Line Number ext Owner Phone Number 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

Contractor Office Phone Number Area Code-Contractor Office Phone Number Prefix-Contractor Office Phone Number Line Number ext Contractor Office Phone Number Extension

Contractor Mobile Phone Number

Contractor Mobile Phone Number Area Code-Contractor Mobile Phone Number Prefix-Contractor Mobile Phone Number Line Number ext Contractor Mobile Phone Number 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 & $25.00 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)

# of Temp Pole ($25.00 Inspection fee).

Fees

Phone number of person paying fees

Phone number of person paying fees Area Code-Phone number of person paying fees Prefix-Phone number of person paying fees Line Number ext Phone number of person paying fees 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 $60.00 for the substitution and/or replacement of a contractor.

Please allow City of Sulphur Inspection Office at least 24 hours prior to electric without power inspection.

FOR OFFICE USE ONLY

ENTERED BY: __ DATE: _

PERMIT #: _____ FLOOD ZONE: _ INSPECTOR: ______

Please Do Not Complete The Following Field

PERMITS - Electrical Permit Application