APPLICATION FOR
ELECTRICAL PERMIT
CITY OF ARKADELPHJA, ARKANSAS
JOB
ADDRESS:
PROPERTY: RESIDENTIAL
COMMERCIAL
APPLICANT:
FiRM NAME:
WORK TO BE DONE:
FIRM
ADDRESS:
OWNER:
CITY:
STATE:
ZIP:
OWNER'S ADDRESS:
PHONE:
(
)
CITY:
STATE:
ZIP:
LICENSE NO.:
PHONE:
(
)
EXPIRATION DATE:
Quantity
Description
TOTAL
Quantity
I
Description
[TOTAL
First 10 Outlets at .75 each
Total Carried Forward
11-100 Outlets at .40 each
Service to
&
including
101to500at.25each
"
100 Amps
10.00
501 and up
.15
each
"
200 Amps
15.00
"
400 Amps
25.00
"
600 Amps
40.00
Over 600 Amps
60.00
Motors-1HP up to
&
including 51-IF 5.00
6HP and up
5.00 +.25 per HP
Miscellaneous
Temporary Power Pole
10.00
Non-residential construction surcharge
(.50
per $1,000 contract/job amount)
Application Fee
$10.00 10.00
Minimum Permit Fee
$5.00
COLUMN TOTAL AMOUNT
TOTAL AMOUNT
Comments or Remarks
Issuance of this permit shall be in accordance with Ordinance 0-10-02. Refunds will not be grantedfor invalid
permits as set forth in Section 7 Permit will expire
if
work is not commenced within 180 days
of
issuance or
if
work
is
suspended or abandonedfor 180 days after work is commenced An extension may be requested in writing with
justifiable cause demonstrated
Signature of Electrician
Approved by:
Date:
Date:
Receipt #
Receipt of S
Check #
is Hereby Acknowledged for Above Permit
By
Date:
Submit
click to sign
signature
click to edit
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