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Gordon County Electrical Permit Application Please Print Information Owner’s Name: Owner’s Street Address: Owner’s Mailing Address: (If different from street Applicant’s Daytime Phone Number: Job Address: Directions to job site: Was a building permit issued for this project? Yes No Building Permit Number: Applications which are not associated with a building permit require approval of the building official. Who will be performing this work? ____Licensed Contractor Owner Contractor’s Name: Contractor’s State License Number: Work may only be performed by owner on their personal property. When permitting as owner the owner SHALL NOT hire a non-licensed person to perform this work. The owner or members of his/her immediate family shall perform the work. When hiring a licensed contractor to perform work, that work shall be permitted under the contractor’s name. Provide information regarding work to be performed below: Permanent Service: Temporary Service Pole: for 90 days only) Size of Service, Amps: 60 100 150 200 400 Other: Size of Service is limited to 60 amps for well pumps or signs and 100 amps for barns (unless provided load calculations show otherwise) Type Structure: Work To Be Performed (Check all that apply): New Project, i.e. service, panels, branch circuits Replace existing service Upgrade existing service Replace existing electrical panel Replace / upgrade existing branch circuits Other: Applicant’s Signature: Date: Approved / Rejected by: Date: Fee: Revised 08-07-2012