Application Date:
Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION
1 N. University Drive, Box #302 • Plantation, Florida 33324 • 954-765-4400 • broward.org/building
REQUEST FOR ELECTRICAL INSPECTION
FOR RELEASE OF POWER
NOT AN ELECTRICAL PERMIT
Property Owner’s Name:
Owner’s Phone:
Owner’s Address:
Site Address:
Applicant’s Name:
Applicant’s Phone:
Applicant’s
Relation to the Property (i.e., Tenant, Contractor, etc.):
Primary use:
If the applicant is not the property owner, the applicant will be required to provide a copy of
the written consent or authorization from the owner for them to request power release.
APPLICANT ACKNOWLEDGEMENT:
Request is hereby made for an electrical inspection at the location listed above. The purpose of the
inspection is to determine if the existing electrical service equipment can be safely connected to the electric
utility provider. This application is not a permit and is not authorization to perform any work on the
electric service equipment by any person. The Electrical Inspector
will
perform a visual inspection of the
condition of the electric service equipment and wiring, which includes but is not limited to: risers, conduits,
raceways, clamps, braces, meter cans, enclosures, panel boards, equipment ground rod(s), ground rod
connections, conductors, lugs and meter sockets.
If
the building is not safe/suitable for its intended use, then
the electrical system
will
not be energized.
This inspection does not guarantee the condition of the inspected building or equipment; nor does
it constitute a warranty of any electrical equipment or component and the applicant hereby agrees to hold
Broward County Building Code Services Division and its employees harmless for any claim of liability
or damages associated with the performance of the safety inspection. If discrepancies are found that require
correction, an electrical permit will be required for said work.
Owner: __
State of Florida
County of Broward
Sworn to (or affirmed) and subscribed before me by
means of physical presence or online
Applicant:
State of Florida
County of Broward
Sworn to (or affirmed) and subscribed before me by
means of physical presence or online notarization,
This ____ day of __________, ____20,
notarization, this _____ day of __________, ___20, by
__________ (name of person making statement)
Notary Public Signature:
Seal
by __________
(name of person making statement)
Notary Public Signature: __
Seal
Note: There is a $66 fee associated with this request.
Revised 02-20-2020
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
