City of Somersworth Development Services Dept.

1 Government Way Somersworth NH 03878 (603) 692-9522 Fax: 692-9575

7/28/04 Application For

Map # _____ Lot # ____ Zoning: _____________

Electrical Permit

Location (Street # & Street Name):_________________________________________________ Owner: _________________________________________ Address: _____________________

City: ______________________State: ___ Zip: _______________ Telephone: __________________ Contractor: ______________________________________ Address: ______________________ City: ______________________State: ___Zip: _______________ Telephone: _______________ N.H. Master Electrician License Number: _________________ Estimated Cost _________________

Residential Property Yes

Device 100 amp 200-400 400-600 600-800 800-1K 1K plus Special Outlets 1-9 KW 10-24 KW 25 plus KW

Commercial Property

No (Is this work for a NEW LIVING UNIT?)

Fee Each $ 5.00 $ 7.00 $ 9.00 $ 12.00 $ 15.00 $ 18.00 Fee Each $ 5.00 $ 8.00 $12.00 No No New Meters Domestic Quick Rec. Off Peak Primary Power Fee Each $ 4.00 $ 4.00 $ 4.00 $ 4.00 $ 4.00 No Devices Outlets Light Fix. Switches GFIC Fee Each $ .50 $ .50 $ .50 $ 1.00 No Fixtures Smoke Det. Flouresc. Neon Hi-Intens 1000 w/+ Other Fee Each $ 3.00 $ 3.00 $ 3.00 $ 3.00 $ 5.00 $ 5.00 $ 3.00 $ 3.00 $ 5.00 No Fee Each $ 2.00 $ 1.00 $1 /4 $ 10.00 $ 10.00 No

Equipment Range Oven Washer Dryer HW Heater Air Cond. Hair Dryer Disposal Motors

*** When Applicabl e Plans must be submitted to Somersworth Fire Dept for Approval

Fee Each $ 4.00 $ 4.00 $ 4.00 $ 5.00 $ 5.00 $ 4.00 $ 5.00 $ 3.00 $ 3.00

No

Equipment Oil Burner Kitchen Fan Bath Fan Elect. Ht <10KW Elect. Ht>10KW Compressor Microwave Paddle Fan Motors hp +

Description Of Work

Revised 04-2004

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Total Permit Fees: Services Meters Devices Fixtures Special Outlets Equipment
TOTAL Minimum Fee is 10 dollars If total is less than 10

PAID BY: _________________________ DATE:____________________ RECD BY: __________________ CASH REVERSE SIGNED: CHECK # _____________

*************************(DO NOT WRITE IN THIS SPACE)*************************

Approved By Code Officer: ____________________________________________________________ Date: ________________________

Department of Development Services Code Enforcement Office

Instructions for Permit Applications 1. All information must be printed legibly. 2. Owner name, address and phone number. 3. Location and address of work site. 4. Complete description of work to be done. 5. Number of fixtures, appliances and equipment to be installed. 6. Plans must be submitted on all new buildings and major renovations. Notes: The property owner of record may execute their right to perform their own electrical/plumbing work on their residence if he or she lives at the residence for a period of not less than one (1) year from the date of final approval of this work and the residence is a Single Family Dwelling occupied by the owner of record. It is the responsibility of all contractors, electricians and plumbers to obtain the necessary permits from the Code Enforcement office at City Hall before ANY work has begun. Work must begin within six (6) months of the issuance of any permit. Electricians and plumbers contractors must have a valid license from the State of New Hampshire to obtain a permit. Permits are not transferable. It is the responsibility of the contractor to obtain all inspections required. A rough-in inspection is required before any work is covered, and a final inspection is required when all work is complete. A forty-eight (48) hour notice is required for any inspection. This signed application constitutes consent on the applicants part to allow for all inspections at the property location listed. No permit will be issued until all of the above information is furnished, and all the above conditions met. It is the responsibility of the property owner and/or the contractor to contact PSNH after the City approval sticker has been applied to arrange for hook-up. INSPECTIONS REQUIRED: (48 hours notice required) 1. When rough-in is complete and visible (Rough) 2. When job is complete, but before occupancy (Final). Revised 04-2004 www.somersorth.org Page 2 of 3

Code Enforcement Approval would certify that the applicant could proceed with installing Electrical fixtures in accordance with specifications submitted. Any deviation from the specifications submitted will require an amendment to this permit or additional permits. If you have any questions, feel free to contact the Code Enforcement office at 692-6522 or 692-9520. Statement of Compliance: I have read and understand the statement and hereby agree to all of the terms stated therein. I agree to abide by any and all codes relating to my field of work, including all national, state and local codes. I also realize that any false statement made in the application for permit may be grounds for revocation of said permit.

_____________________________________ Applicant Signature

_____________________________________ Date

Revised 04-2004

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