HomeMy WebLinkAboutElectrical Permit Application (fillable)Ver 4.0 01/18/2012 Hawai`i County is an Equal Opportunity Provider and Employer Engineering Date Flood Zone $.00 $5.00 $.00 Application#:A PERMITEE’S SIGNATURE **Permit#: E PARCEL LOT APPROVED BY SIGNATURE ** Signature Required RESIDENTIAL ELECTRIC ONLY ADDITION Check box if Contractor's Mailing Address changed NEW HELCO Check box if Contractor’s Phone No. changed Contractor’s Email Address Contractor’s Mailing Address Cell Phone Phone Lessee/Tenant SERVICE EQUIPMENT AMP. RATING PHASE FEEDER INSTALLATION NO. TO BE INSTALLED DESCRIPTION CHECK NO.SPECIALTY & BRANCH CIRCUITS INSTALLATION (ALL OTHER OCCUPANCIES)FEE BRANCH CIRCUITS INSTALLATION (1 & 2 DWELLING OCCUPANCIES ONLY)DESCRIPTION NON-RESIDENTIAL SOLAR HOT WATER AS-BUILT NO. TO BE INSTALLED SUPPLEMENT TO E TMK#3 DESCRIPTION OF WORK DATE TOTAL FEE NO. TO BE INSTALLED FIRST FIVE 120 V CIRCUITS ADDITIONAL 120 V CIRCUITS OTHER TYPES OF CIRCUITS REPAIR NO WORK STARTED ISLAND COOKING APPLIANCES WATER HEATER DRYER MOTORS ZONE 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 AND AGREE TO COMPLY WITH ALL COUNTY AND STATE LAWS.DATE PLOT SECTION DEPARTMENT OF PUBLIC WORKS BUILDING DIVISION ELECTRICAL PERMIT APPLICATION Legal Owner COUNTY OF HAWAI ‘I License No.VALUATION: $Electrical Contractor SIGN BRANCH CIRCUITS (1 & 2 DWELLING)SERVICE/FEEDER FEES .00 PERMIT FEE ($)PERMIT PERMIT FEE ($)FEE FROM ATTACHED OVERHEAD $PENALTY $.00 WAIVER BRANCH CIRCUITS (ALL OTHER OCC.)OTHER:TYPE OF WORK $.00 $.00 $.00 ALTERATION PROJECT LOCATION: UNDERGROUND METERPOLE PEDESTAL ALTERNATIVE ENERGY PHOTOVOLTAIC GENERATOR HYDROELECTRIC WINDMILL l BUILDING PERMIT# MAIL CONTRACTOR PICK -UP IF NONE SELECTED, PERMIT WILL BE MAILED TO CONTRACTOR (BUILDING DIVISION WILL MAIL THIS PERMIT TO CONTRACTOR’S MAILING ADDRESS ONLY)