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