CITY OF TOMAH PERMIT
CITY OF TOMAH PERMIT #___________
APPLICATION FOR ELECTRICAL PERMIT
819 SUPERIOR AVE, WISCONSIN, 54660
|JOB LOCATION |CONTRACTORS NAME |
| | |
|OWNER |ELECTRICAL CONTRACTORS LICENSE # |
| |COMPANY ADDRESS |
| |PHONE NO: |
| | |
| |Email: |
Description of Work: _______________________________________________________________________________
FIXTURES CONSISTING OF: (CHECK ALL THAT APPLY)
TYPE TYPE
|SWITCHES & OUTLETS | |STRIP LIGHTING | |
|LIGHT FIXTURES | |ARC,MERCURY,SEARCH, HID LIGHTS | |
|ELECTRIC RANGE | |YARD LIGHTS & STANDARDS | |
|GARBAGE DISPOSAL | |ELEVATORS | |
|DISHWASHER | |SIGNS | |
|CLOTHES DRYER | |INGROUND POOL | |
|WATER HEATER | |ABOVE GROUND POOL | |
|REFRIGERATING-A/C | |HOT TUB, SPA, WHIRLPOOL | |
|FEEDERS-#8 A.W.G. OR LARGER | |WIRING FOR TEMPORARY USE | |
|SERVICE CONDUCTORS & SERVICE SWITCH | |CONSTRUCTION | |
| SERVICE | |FESTIVALS | |
|SIZE | | | |
|FUEL DISPENSING & WATER PUMPS | |TEMP SERVICE: HOW LONG? | |
|RECTIFIERS, TRANSFORMERS, & GENERATORS | |CRANES & HOISTS | |
|SPACE HEATING EQUIPMENT | |SIGNAL, COMMUNICATION DEVICES | |
|FURNACES, HEATING DEVICES | |FIRE, SMOKE, & CO2 ALARMS | |
|POWER RECEPTACLES | |FIRE ALARM PANELS & CONTROLLERS | |
|1-30 AMPS | |FURNACE REPLACEMENT | |
|>30 AMPS | |WATER HEATER REPLACEMENT (GAS TO ELECTRIC) | |
|MOBILE HOME | |A/C REPLACEMENT | |
| | |OTHERS NOT LISTED: | |
ESTIMATED COST _______________
FEE SCHEDULE
COST FEE
Up to $1,000.00 $25.00
$1001.00 to $2500.00 $40.00
$2501.00 to $4000.00 $45.00
$4001.00 to $6000.00 $50.00
$6001.00 to $8000.00 $55.00
$8001.00 to $10,000.00 $60.00
Over $10,000.00 $60.00 plus $2.50 per thousand
In excess of $10,000.00
TOTAL FEE :______________
-FAILURE TO OBTAIN PERMIT PRIOR TO WORK, EXCEPT EMERGENCY CASES: -FIRST OFFENSE, DOUBLE FEES
CALL 374-7429 FOR INSPECTIONS- 48 HOUR NOTICE REQUIRED
________________________________________ _________________________________________
CONTRACTORS SIGNATURE DATE
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