Date:
Permit Number:
Plan Check #:
Project Address: Zone:
Name:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
Project Contact:
Address:
City/State/Zip:
License Number:
Company Name:
Address:
City/State/Zip:
Proposed Use of Building:
License Number:
Name:
Company:
Address:
City/State/Zip:
Phone:
Fax:
E-Mail Address:
Phone:
Fax:
E-Mail Address:
License Type:
Phone:
Fax:
E-Mail Address:
Current Use of Building:
The City of Galva may require written approval from the owner
City of Galva
311 N. W. 4th Avenue
Galva, IL 61434
Phone: (309) 932-2555
Fax: (309) 932-3306
www.galvail.gov
Electrical Permit
Application
Property Owner
Contractor
NONRESIDENTIAL
Addition to Existing Alteration/Repair Demolition RelocateNew Construction
Owner - Builder
RESIDENTIAL
Tenant Architect Designer Engineer
Purpose of Application
Page 1 of 2
Cost of Improvement (labor + materials + overhead + profit) Rounded to Nearest Dollar:
Is this permit in conjunction with a building permit?
Yes No
Description of
Proposed Work
(example: 3
circuits for attic
receptacles)
Insurance Coverage
I hereby certify that the proposed work is authorized by the owner of record and that I have been
authorized by the owner to make this application as his/her authorized agent and I/we agree to conform
to all applicable laws of this jurisdiction and those of the State of Illinois and the Federal Government.
Page 2 of 2
Number of Feeders and Ampacity:
Overhead Undgrd
Signature of Applicant:
Calculated Permit Fee:
Date:
Approved by:
Existing Service Amps:
Specify: Expires:
No. of Meters:
New Service Amps: New Service Volts:
Overhead Undgrd
No. of Meters:
Existing Service Volts:
No. of Recessed Fixtures:
No. of Lighting Outlets:
No. of Lighting Fixtures:
No. of Receptacle Outlets:
No. of Ranges:
No. of Heat Pumps:
No. of Air Conditioners:
No. of Water Heaters:
No. of Signs:
No. of Motors:
No. of Transformers:
Water Heater(s) KW:
No. of Sign Ballasts:
Total Motor HP:
Total Transformer KVA:
Total Generator KVA:
No. of Zones:
No. of Detecting Devices:
No. of Alerting Devices:
No. Self-Cntnd Devices:
Where Monitored:
Heat Pump Tons:
Total Tons A/C:
Heat Pump KW:
No. of Waste Disposers:
No. of Dishwashers:
No of Dryers:
No. Hydromassage Baths:
No. of Ceiling Fans:
No. of Hot Tubs:
No. of Oil Burners:
Space/Area Heat KW: Heating Appliances KW:
No. of Gas Burners:
Fire Alarms
No. of Generators:
No. of Emergency Lighting Battery Units: Other:
No permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including
"completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has
exhibited proof of same to the permit issuing office.
Check One:
Insurance Bond Other
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