ELECTRICAL PERMIT APPLICATION

COUNTY
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~ OF HENRICO.VIRGINIA
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'. QFfiCE OF ' . ,

BUILDINGCON&RYGTION AND INSPECTIONS
4301 E. PARHAM,RoAD RlCHMOrJD, HENRICO VA 23228
90775 HENRICO
P.O. BOX 270%~'*,J@CHMO?JD,VA "23273-7032
..wwvj~oc:~enricova.uslbldg
PHONE &4).!@#-4360 i:FAX'(w) 501-4984
I N S P E C T l O N - k .,~ ~ U E $ T -755-4300
501-5490
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APPLICATION DATE
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ELECTRICAL BUILDING
PERMIT PERMIT

Value of Work
-
$0.00 $1,000.00
-
$1,000.01 $2,000.00
-
$2,000.01 $3,000.00
-
$3,000.01 $4,000.00
$0.00
SIGNATUREOFOWNER For amounls overS40W. the lee shall be ~ 4 . 0 0 p l u s14.04 looreach addltionalStW0.W
or fraction thereof

COUNTY OR CiTY 'OR CURRENT PERCENTAGE PLEASE CONT

DATE I WITNESS

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lmrpecfed i tested and any response actions It is understood that all work andmateria used In this installation shall conform strictlv with the Uniform Statewide)
taken shall comply with NESHAP and OSHA Building Code and applicable County Codes and that the permit will be void if work is not commenced within 6
standards or exempt from these standards.
months from date of Issue. or the work is suspended I abandoned for 6 months.
NOTE: This office requires submittal of Plans and Specifications or wiring Diagrams showing wiring, conduits,
1 SiGNATUREOFOWNERlAPPLlCANT
switches and overcurrent protection or conductors of all service, main and subfeeders on all insfallations involving
more than 200 amperes, except for one or two family dwellings or when work involved is of a minor nature.