HomeMy WebLinkAboutElectricPermit
Electrical Permit Application
P O Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
www.oshkoshwi.gov
Project
Address
________________________________________________________________________________________
Applicant □ Owner □ Contractor □ Tenant □ Other (describe)__________________________________
Owner /
Tenant
Name__________________________________________________ Phone___________________________
Address_____________________________________________ Email______________________________
Contractor Company Name__________________________________________ Phone____________________________
Contact______________________________________________ Email_______________________________
Address__________________________________________________________________________________
State Credential #’s____________________________________ , __________________________________ Electrical Contractor Registration Lic # Master Electrician Lic #
Type of
Work
□ Temporary Service □ New Service □ Service Change
□ New Wiring □ Addition/Remodel □ Annual Permit
□ Misc– Other than Buildings
Use □ Residential □ Commercial
Volts/Amps _________/_________ volts _________________ amps
Electric
Type
□ Overhead □ Underground
Project
Description
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Value of Job $ ____________________ (Value for materials & labor is req. to ensure consistency in accessing permit fees for all applicants.)
Payment by: □ Check #_______________ □ Cash □ Credit/Debit Card (office or online only)
I certify the above information is complete and accurate. Any deviations from the above submitted information may require ad ditional permits
to be obtained. I acknowledge and agree to these terms.
Name: _____________________________________________ (Please print) Date: _______________________
Master Electrician’s Signature: ___________________________________________