Electrical Permit Application - city.milwaukee.gov

1 Instructions: 1) Type or print a separate form for each location. 2) Return all copies with fee to: milwaukee Development Center, 809 N. Broadway, milwaukee , WI 53202-3617 PH: (414) 286-8207 FAX: (414) 286-0251 Electrical Permit Application No refund on minimum fee Permit CALL (414) 286-2532 FOR INSPECTIONS LOCATION (exact street address) COST OF JOB OCCUPANT PHONE OWNER S NAME ADDRESS USE OF PROPERTY Are other trades working on job site? Yes No Use code (office use only) Checked by Electrical work being performed in connection with: 3600 RAP (Residential 1 & 2 family affidavit) bold equipment only 3100 New construction 3200 Remodeling/alteration 3300 Additional rooms/areas 3400 Repair 3500 New occupancy Electrical equipment to be installed REMARKS Qty Rating Item Unit Fee* Total (HP) Air Conditioner 1 & 2 Family $ (HP) Air conditioner (Other than 1 & 2 family)

2 $ $ Dishwasher $ Dryer or dryer outlet $ Feeder or sub feeder change Furnace with motor $ AVAILABLE SHORT CIRCUIT DATA Garbage Disposal $ It is hereby agreed between the undersigned as owner, by himself, or his agent, and the city of milwaukee , that for and in consideration of the Permit to be issued by the Commissioner of city Development that the Electrical equipment described in this Application will be installed or altered in accordance with the regulations of Chapter 222 of the milwaukee Building and Zoning Code and all amendments thereto and with all other laws and ordinances pertinent thereto. It is further agreed that an Electrical licensee duly licensed under the regulations of Chapter 222 will install the Electrical equipment as described in this Application for Permit in a safe, legal, and workmanlike manner as regulated in Chapter 222 aforesaid.

3 It is further agreed between the undersigned as owner, by himself, or his agent, and the city of milwaukee , that for an in consideration of the Permit for installation or alteration of Electrical equipment as above described, to be issued and granted by the Commissioner of city Development, that the owner hereby grants a city of milwaukee Electrical inspector the right to enter the above designated premises during usual working hours in order to make all inspections that the Department of Neighborhood Services deems necessary to determine if all laws and regulations pertaining to the above designated Electrical equipment have been complied with. If RAP, undersigned certifies that the covered work conforms to all regulations and that all work has been performed in a safe, legal, and workmanlike manner. I further declare that an asbestos project as defined in Chapter 66 of the milwaukee Code of Ordinances will not be included in the work performed under this Permit .

4 Luminaire new or replacement $ Luminaire repair $ (HP) Motor (per HP or fraction thereof for each motor) $ Outlet for fixture, lamp, switch, receptacle, etc. $ Range or range outlet $ Reinspection fee $ (KW) Solar PV Not to exceed $ per unit $ Sump Pump $ Water heater or water heater outlet $ Name of contractor or maintenance licensee Total switch capacities: Single-phase/Multi-phase Address of licensee Permit Processing Fee $ $ city ST ZIP TOTAL Permit FEE MINIMUM FEE: $65 1 or 2 family; $75 condos and all other Phone Electrical License No.

5 Signature of Supervising Electrician *See city of milwaukee Code of Ordinances for complete fee schedule. Copies to Inspector, Office, Applicant rvsd012011