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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