Electrical Application and Permit by gyvwpsjkko

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									                              Electrical Application and Permit
Garrett County                                                                                          2008 Maryland Highway
Planning and Land                                                                                       Suite 3
Development                                                                                             Mt Lake Park , Md 21550
Permits and Inspections                                                                                 Ph 301-334-7470
                                                                                                        Fax 301-334-7469

 Permit Number ___________

 Applicant       _________________________                                               Phone ________________

 Address       _________________________ City ____________ State ____ Zip______
 Location _________________________                               Present Use     __________________
     Tax Map ___ Parcel ___  Grid: __                             Lot    __      Subdivision:___________

                          Type of Project:   _____________________
 Power Company            Allegheny Power                               Size of Electrical Service:________

                        _____ Existing Service _____ Service Upgrade _____
               New Service
          Electrician ______________________ License # ___________

     Fee $10.00                 Date Paid                                Check Number:
    I HEREBY CERTIFY THAT I AM
    ____ the owner of the residential property for which this application is being made
    and shall be responsible for the electrical installation, all required inspections
    and approvals and acknowledge that I am prohibited from hiring an unlicensed
    contractor or person to complete the electrical installation being applied for with
    penalty of violation and forfeiture of this permit.

    ____ the Master Electrician (licensed within the State of Maryland) for the
    electrical installation being applied for and shall be responsible for all required
    inspections and approvals.                      Electrical Inspection Agency
                                                             MDIA ___ MEGCO ___ OTHER ___
     Signature ____________________________________                     Date _____________

     __________________________________________________________
     Permit Approved ____________________________                       Date ___________

                              FOR ELECTRICAL INSPECTOR ONLY
                   Please fax this form to Permits and Inspections upon completion of each inspection
      Required Inspections              Date Requested         Correction Date          Date Complete
       Service Inspection              ________________        ________________         _______________

       Rough Inspection                ________________        ________________         _______________

       Other Inspection                ________________        ________________         _______________

       Final                           ________________         ________________        _______________



               Electrical Inspector – Print ____________________________         Signature ________________________

								
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