ELECTRICAL SUBCODE
TECHNICAL SECTION
A. IDENTIFICATION - APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL PA ONE CALL 8-1-1 OR 1-800-242-1776 BEFORE DIGGING.
Work Site Location ______________________________________________________________________________
______________________________________________________________________________________________
Owner in Fee: __________________________________________________________________________________
Tel. _______ ________________________ Email ________________________________________________
Address _______________________________________________________________________________________
street municipality zip code
Contractor: _______________________________________________ Tel. _______ ______________________
Address _________________________________________________ Email ______________________________
______________________________________________________________________________________________
Electrical License No. ______________________ Issuing Municipality ________________ Exp. Date __________
Home Improvement Contractor Registration No. or Exemption Reason _____________________________________
CIty of Allentown Business License No. _______________________________ Exp. Date ____________________
B. ELECTRICAL CHARACTERISTICS
Use Group Present ___________________________ Proposed _____________________________
[ ] Pole/Pad # __________________________ [ ] Temporary [ ] Other ____________________
Building Occupied as ________________________________ Utility Co. _____________________________
Est. Cost of Elec. Work $ ____________________________ PPL Job # ____________________________
JOB SUMMARY (Office Use Only)
PLAN REVIEW INSPECTIONS DATES (Month/Day)
[ ] No Plans Required ____________ Type: Failure Failure Approval Initial
INITIAL
[ ] Patrial - Underslab Utilities Approved
Date:________ Approved by:__________
[ ] Electric Plans Approved
Date:________ Approved by:__________
Joint Plan Review Required:
[ ] Bldg. [ ] Plumb. [ ] Fire. [ ] Elev.
SUBCODE APPROVAL for PERMIT
Date: _____________________________
Approved by: _______________________
SUBCODE APPROVAL for CERTIFICATE
[ ] CO [ ] CCO [ ] CA
Date: _____________________________
Approved by: _______________________
Rough ______ ______ ______ ______
Barrier Free ______ ______ ______ ______
Trench ______ ______ ______ ______
Temp. Serv. ______ ______ ______ ______
Constr. Serv. ______ ______ ______ ______
TCO ______ ______ ______ ______
Other ______ ______ ______ ______
Service ______ ______ ______ ______
Final ______ ______ ______ ______
Barrier-Free ______ ______ ______ ______
Temp. Cut-in-Card Date Issued ________________________
Final Cut-in-Card Date Issued ________________________
Annual Pool Inspection ______ ______ ______ ______
Date of Grounding and Bonding
Certification __________________________
C. CERTIFICATION IN LIEU OF OATH
I hereby certify that I am the (agent of) owner of record and am authorized to make this
application and perform the work listed on this application.
Applicant sign/Contractor
sign and seal here: ______________________________________________
Print name here: ______________________________________________________
[ ] Licensed Elec. Contractor [ ] Certif’d Landscape Irrigation Cont’r
[ ] Exempt Applicant [ ] Owner
D. TECHNICAL SITE DATA
DESCRIPTION OF WORK:
QTY. SIZE ITEMS FEE (Office Use Only)
____ Lighting Fixtures
____ Receptacles
____ Switches
____ Detectors
____ Light Poles
____ Motors - Fract. HP
____ Emergency & Exit Lights
____ Communications Points
____ Alarm Devices/F.A.C. Panel
____ __________________________
____ TOTAL NUMBERS $__________________
____ Pool Permits/with UW Lights __________________
____ Storable Pool/Spa/Hot Tub __________________
____ _____ KW Elec. Range/Receptacle __________________
____ _____ KW Oven/Surface Unit __________________
____ _____ KW Elec. Water Heater __________________
____ _____ KW Elec. Dryer/Receptacle __________________
____ _____ KW Dishwasher __________________
____ _____ HP Garbage Disposal __________________
____ _____ KW Central A/C Unit __________________
____ _____ HP/KW Space Heater/Air Handler __________________
____ _____ KW Baseboard Heat __________________
____ _____ HP Motors 1/+ HP __________________
____ _____ KW Transformer/Generator __________________
____ _____ AMP Service __________________
____ _____ AMP Subpanels __________________
____ _____ AMP Motor Control Center __________________
____ _____ KW Elec. Sign/Outline Light __________________
____ _____ __________________________ __________________
Archive Fee $ ___________________
Certificate of Occupancy $ ___________________
State Permit Surcharge Fee $ ___________________
TOTAL FEE $ ___________________
Master Permit #
Permit #
