Electrical Permit Application Form

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BUILDING
ELECTRICAL PERMIT APPLICATION
ELECTRICAL
PERMIT #___________
JACKSON HOLE FIRE/EMS
PERMIT#___________
TYPE OF WORK:
Building Address_________________________________
Line
Date of Application _______________________________
□ New Single Family Residence
AMP
□200
□400
Name _____________________________________
□ over 400 – Plan Review Required
Address ____________________________________
□ New Commercial
Plan Review Required
City __________ St______ Phone _______________
□ Addition or Remodel
Name _____________________________________
□ Residential describe:________________________
______________________________________________
Address ____________________________________
□ Commercial describe: _______________________
City __________ St ______ Zip Code _____________
______________________________________________
License# ______________ Phone _______________
Email Address:_______________________________
Low Voltage
□ Alarm/Security
□ Audio/Video
I agree to perform the work described herein in
accordance with the plans and/or specifications
□ Other -describe:________________________
submitted and with all provisions as adopted by Teton
Temporary Service
County and the Town of Jackson.
□-$25.00
Payment Type Cash
Check
#____ Credit Card
E Check
Electrical Contractor’s Signature
TOTAL PERMIT FEES:
Revised 05/09
ELECTRICAL FEE SCHEDULE
Valuation of Electrical Work
Fee
Fee
Fee
1.00
to
500.00
27.23
1,700.01
to
1,800.00
73.21
12,000.01
to
13,000.00
232.43
500.01
to
600.00
30.75
1,800.01
to
1,900.00
76.78
13,000.01
to
14,000.00
246.57
600.01
to
700.00
34.32
1,900.01
to
2,000.00
80.30
14,000.01
to
15,000.00
260.70
700.01
to
800.00
37.84
2,000.01
to
3,000.00
90.86
15,000.01
to
16,000.00
274.89
800.01
to
900.00
41.36
3,000.01
to
4,000.00
105.00
16,000.01
to
17,000.00
303.22
900.01
to
1,000.00
44.94
4,000.01
to
5,000.00
119.13
17,000.01
to
18,000.00
317.35
1,000.01
to
1,100.00
48.46
5,000.01
to
6,000.00
133.32
18,000.01
to
19,000.00
331.49
1,100.01
to
1,200.00
51.98
6,000.01
to
7,000.00
147.46
19,000.01
to
20,000.00
345.68
1,200.01
to
1,300.00
55.55
7,000.01
to
8,000.00
161.65
20,000.01
to
21,000.00
359.81
1,300.01
to
1,400.00
59.07
8,000.01
to
9,000.00
175.78
21,000.01
to
22,000.00
374.00
1,400.01
to
1,500.00
62.59
9,000.01
to
10,000.00
189.92
22,000.01
to
23,000.00
388.14
1,500.01
to
1,600.00
66.17
10,000.01
to
11,000.00
204.11
23,000.01
to
24,000.00
402.27
1,600.01
to
1,700.00
69.69
11,000.01
to
12,000.00
218.24
24,000.01
to
25,000.00
416.96
25,000.01
to
50,000.00
$416.96 for the first $25,000.00 plus $10.62 for each additional $1,000.00 or fraction thereof, to
and including $50,000.00
50,000.01
to
100,000.00
$682.33 for the first $50,000.00 plus $7.10 for each additional $1,000.00 or fraction thereof, to
and including $100,000.00
100,000.01
and up
$1,037.08 for the first $100,000.00 plus $5.89 for each additional $1,000.00 or fraction thereof
Temporary Services
A fee of $25.00 will be charged for all temporary services to be connected

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