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City of Oldsmar Application for Electrical Permit

2. 2015 NATIONAL ELECTRICAL CODE APPLIES

4. Permit # _________________________

5. Permit Fees $____________________

6. Date Received: ________________________

8. TECO LAYOUT NUMBER IS REQUIRED PRIOR TO ISSUING PERMIT

   ***TEMPORARY/FINAL POWER CANNOT BE RELEASED WITHOUT THIS NUMBER***

10. Property Owner's Name

11. Phone

12. Address

14. Contractor's Name

15. Address

16. Email

18. Phone

19. Contractor's State License

20. PCCLB No.

21. Total job cost

23. Job Address

24. Legal Desc/Parcel ID

26. Job Description

28. Electrical Permit Fees
    

30. New Residential (including closets):
    Room Count _______________ x $15.00 = _____________________ + $50.00=__________________

    Room Count _______________ x $15.00 = _____________________ + $50.00=__________________

32. New Commercial or Industrial:
    # per/amp service _____________ x $1.00 = _____________________ + $50.00 = __________________

    # per/amp service _____________ x $1.00 = _____________________ + $50.00 = __________________

34. Residential Alteration or Remodel:
    Fixture/outlet count _______________ x $2.50 = _____________________ + $50.00 = __________________

    Fixture/outlet count _______________ x $2.50 = _____________________ + $50.00 = __________________

36. Commercial Alteration or Remodel:
    Fixture/outlet count _____________ x $3.00 = _____________________ + $50.00 = __________________

    Fixture/outlet count _____________ x $3.00 = _____________________ + $50.00 = __________________

38. Low Voltage:
    Fixture/outlet count _____________ x $2.50 = _____________________ + $50.00 = __________________

    Fixture/outlet count _____________ x $2.50 = _____________________ + $50.00 = __________________

40. Commercial Low Voltage:
    Fixture/outlet count _____________ x $3.00 = _____________________ + $50.00 = __________________

    Fixture/outlet count _____________ x $3.00 = _____________________ + $50.00 = __________________

42. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.

44. AN ELECTRONIC VERSION OF ALL DOCUMENTS BEING SUBMITTED SHALL BE PROVIDED WITH THE PACKET IN .PDF FORMAT IF PLANS ARE LARGER THAN 11 X 17
    Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.

    Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.

46. I understand that a separate permit must be secured for BUILDING, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, KITCHEN HOODS, FIRE SPRINKLERS, ALARM SYSTEMS, AND SHEDS, ETC.
    OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and zoning.

    OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and zoning.

48. OWNER'S ELECTRONIC SUBMISSION STATEMENT: Under penalty of perjury, I declare that all the information contained in this electrical permit application is true and correct.
    Building Permit Applications shall be submitted on paper and PDF format for review and contain all the items listed. In addition, building, plumbing, mechanical and environmental plans shall be submitted to secure this permit, when applicable. The construction permit fee is based on a $50.00 fee, plus additional fees according to the scale above.

    Building Permit Applications shall be submitted on paper and PDF format for review and contain all the items listed. In addition, building, plumbing, mechanical and environmental plans shall be submitted to secure this permit, when applicable. The construction permit fee is based on a $50.00 fee, plus additional fees according to the scale above.

50. Application is valid for 180 days. Permit is extended for 6 months after each successful inspection. Permit expires after 1 year. Permit fee is non-refundable.
    Contractors must maintain, State License, PCCLB License and Workman Compensation Insurance.

    Contractors must maintain, State License, PCCLB License and Workman Compensation Insurance.

52. Print Name

53. Select One

    1. Owner

    1. Authorized Agent

    1. Contractor

55. Signature: _____________________________________________

56. Date: _______________

58. Approved by:_________________________________________________

59. Date:________________

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60. Print Only

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