Application for Electrical Permit

Code Enforcement Department

Job Information

Application Type *

Job Type *

Residential Commercial

To the Board of Commissioners of Springfield Township:

I (We) hereby apply for a permit to construct the following work (give exact location)

Item

Number

Ceiling Outlets

Ceiling Outlets Number

Switches

Switches Number

Plug Receptacles

Switches Number

Total Outlets

Switches Number

Air Heaters

Switches Number

Ranges

Switches Number

Signs

Switches Number

Water Heater

Switches Number

Lighting Circuits

Switches Number

Other Circuits

Switches Number

Total Circuits

Switches Number

Motors

Switches Number

Panel Size

Range Cond.

Sub Feeder Size

Describe the Work to be Performed: *

Estimated Cost (All Trades) *

Permit Fee *

Date Work Will Commence *

Units

State Surcharge

Fee Calculation *

Use the Drawing Tool to Sign the Form in the Box Below

Applicant Signature

Applicant Email Address *

Application Date *

Participant Information

Not withstanding the issuance of this permit, all provisions of the Building and Zoning Codes will be complied with, whether specified herein or not.

Owner Name *

Owner Phone Number *

Owner Address *

City *

State *

Zip *

Architect Name

Architect Phone Number *

Architect Address

City

State

Zip

Contractor Name

Contractor Phone Number *

Contractor Address

City

State

Zip

Applicant Name *

Applicant Phone Number *

Applicant Address *

City *

State *

Zip *

Payment Information

Payment Amount Due

Application for Electrical Permit

Code Enforcement Department

Job Information

Participant Information

Payment Information

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