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Get ME Electrical Permit Application

ELECTRICAL PERMIT APPLICATION STATE OF MAINE DEPARTMENT OF PROFESSIONAL FINANCIAL REGULATION OFFICE OF PROFESSIONAL OCCUPATIONAL REGULATION ELECTRICIANS EXAMINING BOARD 35 STATE HOUSE STATION AUGUSTA ME 04333 TEL 207 624-8457 FAX 207 624-8636 HEARING IMPAIRED 1-888-577-6690 Location 76 Northern Avenue Gardiner Maine Office Use Only Check Amount Cash Permit 4220-1441 PERMIT FEES ARE NON-REFUNDABLE MINIMUM FEE 75. 00 ELECTRICIAN INFORMATION PLEASE PRINT ONLY A LICENSED MASTER OR LIMITED ELECTRICIAN MAY OBTAIN AN ELECTRICAL PERMIT Name Mailing Address City State Zip Code Telephone License By my signature I hereby certify that the information provided on this application is true and accurate to the best of my knowledge and belief. By submitting this application I understand that I am legally and professionally responsible for compliance with all laws and rules enforceable by the board with respect to the installation for which the permit is requested. Electricians Examining Board Rule 02-318 Chapter 135. SIGNATURE OF ELECTRICIAN DATE PAYMENT OPTIONS Make checks payable to Maine State Treasurer if you wish to pay by Mastercard or Visa fill out the following Name of cardholder please print FIRST MIDDLE INITIAL LAST I authorize the Department of Professional and Financial Regulation Office of Professional Occupational Regulation to charge my VISA MASTERCARD the following amount Card number XXXX XXXX XXXX XXXX SIGNATURE Expiration Date mm / yyyy LOCATION OF BUILDING WORKSITE Commercial/2-Family Street/Road County Single family temporary service only Town/City Landmarks Be Specific OWNER CONTINUE ON BACK SCOPE OF WORK FEE SCHEDULE - CHECK ONE PERMANENT 1 and 3 phase through 800 amperes 1 and 3 phase 801 and larger Panels remote from the main service Recreational vehicle park sites Receptacles switches luminaries electrical heating units permanently connected appliances and outside lighting and signs Transformers Not utility owned Motors and Generators Motors fractional Motors 1 hp and larger Generators emergency required standby optional Electrical Alarm Systems Energy Management Systems Alternative Energy Systems Photovoltaic Wind Micro-Hydro Fuel Cell Other Systems Control wiring HVAC TOTAL DUE 75. 00 ELECTRICIAN INFORMATION PLEASE PRINT ONLY A LICENSED MASTER OR LIMITED ELECTRICIAN MAY OBTAIN AN ELECTRICAL PERMIT Name Mailing Address City State Zip Code Telephone License By my signature I hereby certify that the information provided on this application is true and accurate to the best of my knowledge and belief* By submitting this application I understand that I am legally and professionally responsible for compliance with all laws and rules enforceable by the board with respect to the installation for which the permit is requested* Electricians Examining Board Rule 02-318 Chapter 135. SIGNATURE OF ELECTRICIAN DATE PAYMENT OPTIONS Make checks payable to Maine State Treasurer if you wish to pay by Mastercard or Visa fill out the following Name of cardholder please print FIRST MIDDLE INITIAL LAST I authorize the Department of Professional and Financial Regulation Office of Professional Occupational Regulation to charge my VISA MASTERCARD the following amount Card number XXXX XXXX XXXX XXXX SIGNATURE Expiration Date mm / yyyy LOCATION OF BUILDING WORKSITE Commercial/2-Family Street/Road County Single family temporary service only Town/City Landmarks Be Specific OWNER CONTINUE ON BACK SCOPE OF WORK FEE SCHEDULE - CHECK ONE PERMANENT 1 and 3 phase through 800 amperes 1 and 3 phase 801 and larger Panels remote from the main service Recreational vehicle park sites Receptacles switches luminaries electrical heating units permanently connected appliances and outside lighting and signs Transformers Not utility owned Motors and Generators Motors fractional Motors 1 hp and larger Generators emergency required standby optional Electrical Alarm Systems Energy Management Systems Alternative Energy Systems Photovoltaic Wind Micro-Hydro Fuel Cell Other Systems Control wiring HVAC TOTAL DUE 75. .

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