Temporary Electrical Power Letter Template - City Of Fort Worth Planning & Development Department
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1City of Fort Worth – Planning & Development Department – Electrical Division
Application for Temporary Electrical Power
Fax Number – 817-392-8116
Temporary Electrical Power Letter
All Temporary Electrical Power letters must be approved by an electrical inspector and a fee, as specified in the
Electrical Code, is required prior to the inspection by this department. Temporary permits are limited to sixty (60)
days at which time they automatically expire unless extended in writing by an electrical inspector.
The owner/applicant agrees that, if upon inspection of said premises by an electrical inspector; such wiring
methods and/or electrical equipment is/are to be so approved by him/her; the applicant will correct the violation(s)
in conformance with the requirements of City Ordinance 15994 & 16028. The owner/applicant further agrees
that, if any other city inspection violations are so noted; and have not been corrected, or if the changes have not
been made within sixty (60) days after such inspection, the City may have service disconnected to said
owner/applicant until such changes have been made and approval by the electrical inspector has been given.
The owner/applicant agrees to release the City of Fort Worth, and its agents from any and all liability of every
kind and nature for damages to persons and/or property which may occur from defective wiring methods and/or
electrical equipment and hereby agrees to indemnify the City of Fort Worth and its agents for and to hold the City
of Fort Worth and its agents harmless from any and all such liability.
___________________________________________________________________________________________
APPLICANT USE:
WARNING:
Signing of this document does not authorize
occupancy of this structure.
Applicant Initial ____________
rd
Comm: _____ Resd: ______ 3
Party: _____
___________________________________________________________________________________________
Please Check One:
_____ Cold Weather
_____ Clean and Show
_____ New Construction
_____ Ordinance Inspection Turndown
_____ Other
_____ Repair-Remodel w/wo Electrical
Related Permit Numbers (If Applicable): _________________________________________________________
Job Address: ________________________________________________________________________________
Owner/Agent (Print): ____________________________________________ Telephone: ___________________
Master Electrician (Signature): ________________________________________ License #: ________________
Contractor (Print): _________________________________________________ License #: _________________
Return Fax Number: __________________________________________________________________________
I hereby certify that I am the owner/authorized agent of said property and that the information given above is true
and correct to the best of my knowledge. I further agree to the condition of this letter.
__________________________________________
______________________________
Owner/Agent Signature
Date
Payment Methods Available:
Master Card: _____Visa: _____ American Express: _____ Discover: _____
C
ard #: _________________________________ Expire Date: ___________ 3 Digit CVS Code: ________
C
ardholder’s Name: _________________________Card Street Billing Address: _____________________
S
ignature: ___________________________________Card Billing Zip Code: ________________________
___________________________________________________________________________________________
OFFICE USE:
PERMIT #: ________________________________________ Hook-Up Dates: _________________________
Inspectors Signature: __________________________________ Date: _________________________________
Revised 060407.OEE
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