ELECTRICAL PERMIT APPLICATION
Subject Property
Owner
Address
Electrical Contractor (Please Print)
Address
Master Electrician #
Phone
Electrical Permit #
No. Units Now
When Complete
BUILDING DATA
USE: Residential Business Industrial Other________________ Wiring Method: NM AC MC Conduit Other________________
Type of Installation: New Addition Alteration Luminarie Retrofit Repair Other Building Permit # _______________________
Services, Panels, and/or
Disconnects
$5.00 per 100 amps
Qty
Amount
Devices $1.00 ea
Qty
Fixtures $2.00 ea
Qty
60
$ 5.00
Receptacles
Incandescent
100
$ 5.00
Switches
Flourescent
200
$ 10.00
Motion Sensor
Neon
400
$ 20.00
Other
Smoke Detector/CO
600
$ 30.00
Exit/Emergency Lts.
800
$ 40.00
Exh/Paddle Fan
1000
$ 50.00
Total Quantity
Total Quantity
1200
$ 60.00
Device Fee:
Fixture Fee:
1600
$ 80.00
Equipment $5.00 ea
2000
$ 100.00
Range/Cooktop
Washer
Meters
$ 5.00
Wall Oven
Dryer
Motors
$ 5.00
Microwave
Boiler Gas/Oil
Air Compressor/Condenser
$ 15.00
Dishwasher
Furnace Gas/Oil
Electric Heat
$ 5.00
Disposal
A/C Unit
Heat Pump
$ 10.00
HW Heater
Door Openers
Pre‐Mfgd/Temp Site Trlr
$ 50.00
Refrigerator/Freezer
Sump Pump
Modular Homes
$ 75.00
Total Equip. Qty.
Equip. Fee:
Fire Pump
$ 100.00
Transformers
Standard Temp Service
$ 25.00
Up to 25 KVA
$25.00 ea
Illuminated Sign
$ 25.00
25 KVA & Over
$50.00 ea
Above Ground Pool/Hot Tub
$ 25.00
Transformer Fee:
In Ground Pool
$ 50.00
Generators and Transfer Switches
Misc.
Up to 10 KVA
$25.00 ea
Application Fee/Meter Reset
$ 25.00
10 KVA to 75 KVA
$50.00 ea
Over 75 KVA
$100.00 ea
Commercial: $15.00 per $1,000 of construction
Transfer Switches
same as above
value and application fee.
Services, Panels, Disconnect Fee
Generator and Transfer Fee:
TOTAL ELECTRICAL PERMIT FEE
Paid: Check Cash Amount $________ Collected by_______ Date________ Check #_______ Plans Submitted ______
* Permit Fees Doubled if Work is Started Before Permit id Issued
Applicant certifies that all information provided is correct, agrees to allow reasonable notification for inspections, and that all work shall be installed
in compliance with State of NH RSA: 319‐c and all applicable ordinances.
Inspections Required (1) when rough in is complete prior to concealing (2) Upon completion prior to Occupancy
Failure to correct deficiencies which require a third visit for the same issue: Re‐Inspection Fee of $75.00
Description of Work:
Signature of Applicant / Agent
Date
Electrical Inspector/Building Official