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City of Oldsmar Application for Electrical Permit

2. 2020 NATIONAL ELECTRICAL CODE APPLIES

4. Permit #

6. TECO LAYOUT NUMBER IS REQUIRED PRIOR TO ISSUING PERMIT

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

8. Property Owner's Name

9. Phone

10. Address

12. Contractor's Name

13. Address

14. Email

16. Phone

17. Contractor's State License

18. PCCLB No.

19. Total job cost

21. Job Address

23. Legal Desc/Parcel ID

25. Job Description

26. Electrical plan/diagram

28. Electrical Permit Fees
    

30. Room Count:

    New Residential (including closets)

31. # per/amp service:

    New commercial or Industrial

33. Fixture/outlet count:

    Residential Alteration or Remodel

34. Fixture/outlet count

    Commercial Alteration or Remodel

36. Fixture/outlet count:

    Low Voltage

37. Fixture/outlet count:

    Commercial Low Voltage

39. 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.

41. 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.

43. 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.

45. 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.

47. 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.

49. Print Name

50. Select One

    1. Owner

    1. Authorized Agent

    1. Contractor

52. Signature:

    By typing your name here, you are signing this form electronically. You agree you are submitting this application for processing and is the legal equivalent of your manual signature on this form. You must be the legal property owner/qualified license holder or authorized agent which match our registration records.

53. Date:
    Date:

55. Approved by:

Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field