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ElectricalApplication - Electrical Application - Draft Revised

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U.S.A. forms for City of Bridgeport

BROWSE CITY OF BRIDGEPORT (CT) FORMS

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Form1448(4.3.20)

Elec.

PermitNo.

________

PERMITSMUSTBEPOSTEDONJOBSITE 

CITYOFBRIDGEPORT,BUILDINGDEPARMENT

APPLICATIONFORPERMITTODOELECTRICALWORK

Building

Permit#_________

ThisSectionToBeCompletelyFilledOutByApplicant

HOLDHARMLESS/RELEASE

CityofBridgeportandBridgeportBuildingDepartmentrequiresthatpermitteeshallindemnifyandhold‐harmless"City/Department",

it's employeesandagentsand release both from anyandallclaimsonactionsbroughtby third parties for injuries or damagesof

property in connection with granting of this permit and work to be performed there under. Permittee may be required to insure

againstsuchclaimsinamountsappropriatetomeetsuchobligation.City/Departmentshallhavetherighttoreviewandspecify

suchamountandscopeOfcoverageasitmaydeemappropriateforactivitiesconductedunderthispermit.

IHEREBYMAKEAPPLICATIONFORAPERMITTODOELECTRICALWORK‐INACCORDANCE

WITHTHEBUILDINGCODE‐INABUILDINGASHEREINAFTERDESCRIBED:

LocationNo. Street Date

NearestCrossSt Owner Address

KindofBuilding‐  Frame  Brick  Fireproof  New  Old  Addition

SizeofNewService(Amperes) Phase Voltage

ExistingService SizeofWire SizeofConduit

No.ofLightingMeters Owner/HouseMeter

No.ofPowerMeters(3ph/4w) 3Ph/3w

TypeofOccupancy:  ResidentialNumberofFamilies______________Industrial

 CommercialRestaurantSchoolChurchGasStationHealthCareOther__________________

NumberofTenantSpaces___________________NumberofFloors________________

Location

Floor

Light Recept. Switch

Basement

First

Second

Third

Fourth

Fifth

Garage

Total

WiringType:

AC

MC

Romex



PVC

Rigid

Other:

DESCRIBEWORKTOBEDONE:

AttachDetailDrawings(s)

EstimateofValue

ReceiptNo. FEE=

CompanyName Contractor

Contractor'sAddress Signature

TelephoneNo. StateLicenseNo. Classification

AcceptedbyElectricalInspector Dated

ContractorMustReceivePermitBeforeWorkIsStarted

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ElectricalApplication - Electrical Application - Draft Revised

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Completed 11 July 2020

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