Electrical Permit Application

Alliance Integration: This application integrates with our Electrical Code Database, Load Calculation Tools, and Utility Coordination System for streamlined processing and compliance verification.

APPLICANT INFORMATION

Full Name:

_________________________

License Number:

_______________

Business Name:

_________________________

Federal Tax ID:

_______________

Address:

___________________________________

City:

_______________

State:

______

ZIP:

_________

Phone:

_______________

Email:

_________________________

WORK EXPERIENCE

Provide detailed employment history for the past 10 years or since beginning electrical work. Include all relevant electrical experience.

Employer Name	Address	From Date	To Date	Type of Work	Supervisor

Total Years of Experience:

____________

EXAMINATION RESULTS

Examination Date:

_______________

Score:

_________

Pass/Fail:

_________

Testing Agency:

_________________________

Certificate Number:

_______________

Expiration Date:

_______________

Examination Categories Completed:

☐ National Electrical Code

☐ Local Codes & Ordinances

☐ Electrical Theory

☐ Motor Control

☐ Load Calculations

☐ Grounding & Bonding

☐ Hazardous Locations

☐ Business & Law

Alliance Code Database: Verification of examination results will be cross-referenced with our comprehensive electrical code database to ensure current compliance standards.

BUSINESS INFORMATION

Business Structure:

☐ Sole Proprietorship ☐ Partnership ☐ Corporation ☐ LLC

Date Established:

_______________

State of Incorporation:

_______________

Workers' Compensation Policy #:

_________________________

General Liability Policy #:

_________________________

Bonding Company:

_________________________

Bond Amount:

_______________

Bond Number:

_______________

PROFESSIONAL REFERENCES

Provide three (3) professional references who can verify your electrical work experience and competency.

Reference Name	Company	Phone Number	Relationship	Years Known

PROJECT DETAILS

Project Address:

___________________________________

Property Owner:

_________________________

Phone:

_______________

Estimated Cost:

$ _______________

Start Date:

____________________

Completion Date:

____________________

Type of Work (Check all that apply):

☐ New Installation

☐ Renovation/Alteration

☐ Service Upgrade

☐ Panel Replacement

☐ Wiring Addition

☐ Motor Installation

☐ Lighting Systems

☐ Emergency Systems

Description of Work:

_________________________________________________________
_________________________________________________________

Load Calculation Tools: Use Alliance's integrated load calculation software to automatically verify electrical load requirements and ensure code compliance for your project specifications.

COMPLIANCE CERTIFICATIONS

Verify compliance with all applicable codes, regulations, and safety standards.

☐ National Electrical Code (NEC) Current Edition

☐ Local Electrical Code Amendments

☐ State Licensing Requirements

☐ OSHA Safety Standards

☐ ADA Compliance (if applicable)

☐ Environmental Regulations

☐ Fire Safety Codes

☐ Building Code Compliance

Code Jurisdiction:

_________________________

Inspection Authority:

_________________________

SAFETY TRAINING VERIFICATION

Document all current safety training and certifications.

Training/Certification	Certification Date	Expiration Date	Issuing Organization	Certificate #
OSHA 10-Hour	_____________	_____________	_____________________	_____________
OSHA 30-Hour	_____________	_____________	_____________________	_____________
Arc Flash Training	_____________	_____________	_____________________	_____________
Confined Space	_____________	_____________	_____________________	_____________
First Aid/CPR	_____________	_____________	_____________________	_____________

Utility Coordination System: Upon approval, this permit will be automatically coordinated with local utility companies for service connections, disconnections, and inspection scheduling through Alliance's integrated platform.

APPLICANT CERTIFICATION

I hereby certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false information may result in denial or revocation of the electrical permit. I agree to comply with all applicable codes, regulations, and inspection requirements. I acknowledge that this permit does not relieve me of the responsibility to comply with all other applicable laws and regulations.

Applicant Signature:

Signature

Date:

Notary Public:

Notary Signature

Commission Expires:

FOR OFFICIAL USE ONLY

Application Received:

____________________

Permit Number:

____________________

Fee Amount:

$ _______________

Payment Method:

____________________

Reviewed By:

____________________

Date:

____________________

Status:

☐ Approved ☐ Denied ☐ Pending Additional Information

Comments:

_________________________________________________________
_________________________________________________________