Fillable Fillable Electrical Permit Application With Calculations 12 5-19 (Polk County)

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Fillable Electrical Permit Application With Calculations 12 5-19 (Polk County)

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Polk County Public Works
5885 NE 14
th
St. Des Moines, IA 50313
Ph: (515)286-3705 Fax: (515)286-3437
Email: publicworks@polkcountyiowa.gov
Electrical Permit Application
Owner of the Job Site Property:
Job Site Address:
Parcel Number (if site has no address):
Company Name:
State Contractor License No. & Exp. Date:
Company Address (City, State, & Zip):
State Master A or B License No. & Exp. Date:
Phone Number: Email:
Modifications of Service
Sign
No. Fee Each Total
Meters: 1
st
Meter
nd
2
Meter
Each Meter in Excess of Two
Circuits: First 5
Circuits
6
th
-10
th
Circuits
11
th
-100
th
Circuits
Each Circuit in Excess of 100 Circuits
Fixed Appliances at $7.60 a piece
(Below
-
Enter Number of Each)
Air Conditioner: Dishwasher:
Dryer: Electrical Sign:
Furnace: Heat Pump:
Range: Unit Heater:
Other:
Total Number of Fixed Appliances (calculated from those listed above)
Fixtures (Commercial Only)
Motors (Exclusive of Circuits)
Subtotal
Basic Fee
Total Fee
The Undersigned Hereby Makes Application To Perform Work As Described Herein:
I affirm the work described in this application is accurate and correct to the best of my knowledge and that
the aforementioned license holder is
licensed
to perform
electrical work.
I affirm the work described in this application is accurate and correct to the best of my knowledge and that
I am the owner
of this
dwelling
performing work on my existing home or accessory building.
I understand
work must commence within 180 days from the permit issuance date, and be completed and inspected within one year from the
issue date,
or this permit will be null
and void.
I understand all work must be inspected and approved by Polk County prior to concealing any installation
and I must call for the final
inspection for the electrical permit.
I further understand that a Certificate of Compliance is required in accordance with applicable codes and
ordinances.
_______________________________________
_______________________________________________
Print Name Signature
Date______________
Permit Type
(Please Check Appropriate Box)
Commercial:
Residential:
Work Class
(Please Check Appropriate Box)
Additions/Alterations
Meter Pedestal
New Construction
Pool/Spa Service
Temporary Power Pole
Septic
Permit #______________________
Name of license holder:
0
$ 0.00
$ 37.00
$ 37.00
$ 9.20
$ 0.00
$ 6.50
$ 0.00
$ 0.00
$ 4.50
$ 0.00
$ 4.00
$ 0.00
$ 2.60
$ 1.00
$ 0.00
$ 2.00
$ 0.00
$ 4.10
$ 7.60
$ 0.00
$ 0.00
$ 4.60
$ 0.00
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signature
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Electrical Panel / Service
Update / Upgrade / Change-out
Residential Service Update
Service upgrade/ update/ change-out shall be done only by Electrical Contractors licensed by the
State of Iowa
Minimum 20 circuit 100 amp panel
2 ground rods required-6’ apart and outside drip line of eave
Water ground, if available, with jumper wire
Any Federal Pacific panels must be replaced
2 20 amp circuits to kitchen
1 20 amp circuit to laundry
1 20 amp circuit to bathrooms
General Update Requirements
Screw type fuses shall be eliminated
Any new receptacles added must be of the grounding type
Existing non-grounded receptacles may be replaced with the same
Fixtures in kitchen and bath/s must be grounded
Repair all exposed wiring and bring to code
Ground Fault Circuit Interrupter Protections Requirements
Kitchen receptacles
Bathroom receptacles
Unfinished basement receptacles
Garage (attached and detached) receptacles
Smoke Detector Update Requirements
As of April 1, 2010, all smoke detectors added or replaced shall be dual sensing smoke detectors.
Smoke detectors shall be installed in every bedroom, in close proximity to bedrooms and on each
floor level
If existing wall and ceiling coverings are not removed then battery operated smokes are OK
If existing wall and ceiling coverings are removed, or new construction, then hard-wired smoke
detectors are required
Arc Fault Circuit Interrupter Requirement
Bedroom addition/s receptacles or receptacles in a room converted to bedroom shall be AFCI
protected
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Fillable Electrical Permit Application With Calculations 12 5-19 (Polk County)

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Completed 16 July 2020

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