City of Tomah Electrical Permit

City of Tomah Electrical Permit
Job Location *
Owner Name *

First Name Last Name
Owner Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contractor Name *
Contractor Phone *

Area Code Phone Number
Contractor Email *
example@example.com
Electrical Contractors License#
Master Electrician License#
Description of Work
Fixtures Consisting of: (Check all that apply)
SWITCHES & OUTLETS LIGHT FIXTURES ELECTRIC RANGE GARBAGE DISPOSAL DISHWASHER CLOTHES DRYER WATER HEATER REFRIGERATING-A/C FEEDERS-#8 A.W.G. OR LARGER SERVICE CONDUCTORS & SERVICE SWITCH
Service Size
POWER RECEPTACLES 1-30 AMPS >30 AMPS MOBILE HOME STRIP LIGHTING ARC,MERCURY,SEARCH, HID LIGHTS YARD LIGHTS & STANDARDS ELEVATORS SIGNAGE INGROUND POOL ABOVE GROUND POOL HOT TUB, SPA, WHIRLPOOL WIRING FOR TEMPORARY USE CONSTRUCTION FESTIVALS TEMP SERVICE
How Long?
CRANES & HOISTS SIGNAL, COMMUNICATION DEVICES FIRE, SMOKE, & CO2 ALARMS FIRE ALARM PANELS & CONTROLLERS FURNACE REPLACEMENT WATER HEATER REPLACEMENT (GAS TO ELECTRIC) A/C REPLACEMENT
Estimated Cost *
Under $10,000, please input total project value below:
Over $10,000, please input total project value below:
Over 10K Fee Calculation
Project Amount
Fee Schedule
Base Fee
Over 10K Fee
Total Fee
-FAILURE TO OBTAIN PERMIT PRIOR TO WORK, EXCEPT EMERGENCY CASES: -FIRST OFFENSE, DOUBLE FEES
CALL 374-7429 FOR INSPECTIONS- 48 HOUR NOTICE REQUIRED
Contractors Signature

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Date

Month Day Year
Date
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