Electrical Permit Application Form
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1
2PERMIT #__________________
DEPARTMENT OF DEVELOPMENT & PERMITS
Tel.
(757) 382-6018
Code Compliance Division
Fax
(757) 382-8448
P. O. Box 15225
Inspection Request:
(757) 382-2489
Chesapeake, VA 23328
Date:___________________
Email:
develop-permits@cityofchesapeake.net
APPLICATION FOR ELECTRICAL PERMIT
A permit is hereby requested to install electrical work at:
Address__________________________________________________________________ Suite/Lot #__________
Subdivision_____________________________________ Builder/Owner/Occupant__________________________
Electrical Co. Name_____________________________________ State Reg. #_____________________ A B C
Master /Owner Signature_____________________________________________ Phone #__________________
PRINT Signature Name_________________________________________ Ches. Bus. License #____________
Business Address____________________________________________________________________________
Structure is:
_____New
_____Foundation
_____Existing
_____Addition
____Moved
_____Residential
_____Commercial
_____Industrial
______Mobile Home/Trailer
Code Used:
_____NEC
_____International Residential Code
ELECTRICAL SERVICE INFORMATION (Complete this information if applicable)
Work Request #
Work Request No. is required for all new and/or service changes and relocations
New Service Size: ________Amps
______Phase
______Volts
_________Number of Meters
Existing Service Size:_______Amps
(Required Information for Service Change/Upgrades)
Service will be: _____Temporary Power Pole
_____Overhead
_____Underground
New Service Fee ____________
Existing Service Fee
___________ Temporary Pole Fee __________
INSTALLATION
ADDITIONS OR REPAIRS
_____Outlets (Swit, Ltg. Recp)
Indicate number of circuits plus feeders worked on according to the size.
_____
0 – 30 amps
$ 3.00
_____Motors
_______HP
_____
31 – 60 amps
4.00
_____Range
______KW
_____
61 – 100 amps
5.00
_____Water Heater
______KW
_____
101 – 200 amps
10.00
_____Dryer
______KW
_____
Over 200 amps
15.00
_____Heat (Gas or Oil)
_______HP
_____
Pool Bonding & Equip – Inground
30.00
_____A/C & Heat Pump
_______Ton
_____ Pool Bonding & Equip – Above Ground
15.00
_____Hydro-massage tub
____ ___HP
_____
Meter Base Replacement Size ________ amps
5.00
_____Kitchen/Bath Fans
____ __CFM
Other_____________________________________________________
Other_____________________________
Fee
$________________________
Technology Fee $5.00
Contract Value $____________________
Minimum Permit Fee - $40.00
If application is not complete, it may be returned resulting in a delay of inspection. SEE BACK FOR MORE
DETAILED INFORMATION.
Revised 8/19/13
CG-7075/R-09
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