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<br /> <br />MAIL (BUILDING DIVISION WILL MAIL THIS <br /> <br />PERMIT TO CONTRACTOR’S MAILING <br />ADDRESS ONLY) <br />DEPARTMENT OF PUBLIC WORKS <br />‘ <br />COUNTY OF HAWAII <br />CONTRACTOR PICK-UP <br /> <br />BUILDING DIVISION <br /> IF NONE SELECTED, PERMIT WILL <br />ELECTRICAL PERMIT APPLICATION <br /> BE MAILED TO CONTRACTOR <br />BUILDING PERMIT# <br />l <br />$ <br />VALUATION: <br />Legal OwnerElectrical ContractorLicense No. <br />Lessee/TenantContractor’s Mailing AddressPhone <br />PROJECT LOCATION: Contractor’s Email AddressCell Phone <br />Check box if Contractor'sCheck box if Contractor’s <br />EngineeringDateFlood Zone <br />Mailing Address changedPhone No. changed <br />TYPE OF WORK <br />HELCO <br />ALTERNATIVE ENERGY <br />RESIDENTIALNEWADDITIONELECTRIC ONLY <br />OVERHEAD <br />PHOTOVOLTAIC <br />NON-RESIDENTIALSIGNALTERATIONREPAIR <br />GENERATORUNDERGROUND <br />SOLAR HOT WATER AS-BUILTNO WORK STARTED <br />HYDROELECTRIC <br />SUPPLEMENT TO E <br />METERPOLE <br />DESCRIPTION OF WORK <br />WINDMILL <br />PEDESTAL <br />OTHER: <br />SERVICE EQUIPMENTFEEDER INSTALLATION <br />FEES <br />AMP. RATING <br />PHASE <br />NO. TO BE INSTALLED <br />.00 <br />$ <br />SERVICE/FEEDER <br />($) <br />PERMIT FEE <br />BRANCH CIRCUITS INSTALLATION (1 & 2 DWELLING OCCUPANCIES ONLY) <br />BRANCH CIRCUITS <br />.00 <br />FIRST FIVEADDITIONAL <br />(1 & 2 DWELLING) <br />$ <br />COOKINGWATEROTHER TYPES <br />DESCRIPTION <br />DRYERMOTORS <br />120 V120 V <br />APPLIANCESHEATEROF CIRCUITS <br />CIRCUITSCIRCUITS <br />NO. TO BE <br />BRANCH CIRCUITS <br />INSTALLED <br />.00 <br />$ <br />(ALL OTHER OCC.) <br />($) <br />PERMIT FEE <br />SPECIALTY & BRANCH CIRCUITS INSTALLATION (ALL OTHER OCCUPANCIES) <br />FEE FROM <br />.00 <br />$ <br />ATTACHED <br />NO. TO BE <br />DESCRIPTIONFEE <br />INSTALLED <br />.00 <br />$ <br />WAIVER <br />.00 <br />$ <br />PENALTY <br />5.00 <br />$ <br />PERMIT <br />.00 <br />$ <br />TOTAL FEE <br />CHECK NO. <br />Note: If more space is needed, attach a separate sheet. <br />For Electrical Service – Refer to the latest amended version of Chapter 9 of the Hawai‘i County Code. <br />All materials and installation shall comply with the latest amended version of Chapter 9 of the Hawai‘i County Code and Chapter 14 of the Hawai‘i County Outdoor Lighting Code. <br />All work must be performed by individuals who are in compliance with Section 9-17 of the Hawai‘i County Electrical Code. <br />This permit shall become null and void should any work authorized be continuously suspended for a period of 120 days. <br />All refund requests must be received by the Director of Finance within 90 days from issuance date of this permit, as per Chapter 2 of the Hawai‘i County Code. <br />I HEREBY ACKNOWLEDGE THAT THE INFORMATION GIVEN ON THIS FORM IS CORRECT <br />Application#: E <br />A <br />AND AGREE TO COMPLY WITH ALL COUNTY AND STATE LAWS. <br />Permit#: E <br />PERMITEE’S SIGNATURE **DATE <br />PARCELLOT <br />ISLANDZONESECTIONPLOT <br />3 <br />APPROVED BY SIGNATUREDATE <br />TMK# <br />** Signature Required <br />Hawai`i County is an Equal Opportunity Provider and Employer <br />Ver 4.0 01/18/2012 <br />