CHARTER TOWNSHIP OF WATERFORD
5200 Civic Center Dr. Waterford, MI 48329
Phone 248-674-6238 Fax 248-674-4097
www.waterfordmi.gov
APPLICATION FOR ELECTRICAL PERMIT
Permit #_______________
1. JOB LOCAT
ION
Address of Job Location :
Name of Owner
2. APPLICANT INFORMATION
Contractor
Homeowner
Name License Number Expiration Date
Address City State Zip
Telephone Email
Federal Employer ID Number MESC Number Workers Comp Insurance Carrier
3. TYPE OF JOB
Single Family: New Addition Alteration Pre-Manufactured Home Setup
Commercial: New Addition Alteration Special Inspection
4. ELECTRIC
AL PERMIT INFORMATION
Electrical Permit fees for new residential single family homes and condominium units shall be at a flat fee based on the total area of
the structure. This fee shall cover all electrical installations within the structure. Fees for additions, alterations, accessory structures
and all commercial construction have a base fee plus itemized charges for specific work being performed. An Electrical Permit is
valid for a period of one year from the date of issuance. Applicant may request one six-month extension upon payment of the
Electrical Permit Extension fee. Requests for inspections of partially completed work require payment of a Special Inspection Fee.
Any re-inspection fees assessed against an Electrical Permit must be paid prior to scheduling subsequent inspections.
Cancellations and Refunds:
Base permit fees are non-refundable.
Permits cancelled within 3 months of issue with no work or inspections performed 80%
Permits cancelled within 6 months of issue with no work or inspections performed 50%
Permits cancelled within 1 year of issue with no work or inspections performed 25%
Permits cancelled after 1 year of issue with no work or inspections performed 0%
Permits cancelled after work has commenced or inspections performed 0%
5. APPLICANT SIGNATURE
Section 23a of the State Construction Code Act of 1972, 1972PA 230, MCL 125.1523A, prohibits a person from conspiring to
circumvent the licensing requirements of the state relating to persons who are to perform work on a residential building or
residential structure. Violators of Section 23a are subject to civil fines.
Placing a check in the box serves two purposes:
(1) The person filing this application is the actual applicant.
(2) The person filing this application understands and agrees to the above provisions.
Date
6. HOMEOWNER AFFIDAVIT
By placing a check in the box, I hereby certify that I am the homeowner and occupant of, or will, upon
completion of the work and issuance of a Certificate of Occupancy, become the homeowner and
occupancy of this residence and that I will personally install all piping, fittings and fixtures and
perform all work required to comply with the applicable codes and ordinances as adopted by
Waterford Township relative to this permit.
Date
Owner Phone Owner Email
For Office Use Only
PE20-
