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PICKENS COUNTY PLANNING & DEVELOPMNENT 1266 East Church Street, Suite 136 Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] A permit is required on all new construction, repairs, alterations, and miscellaneous projects. Permits may not be issued the same day the application is submitted. An Access/Encroachment permit is required for driveways that access a county- maintained road. An 8 ½”x 11” copy of a survey of the property being permitted is required for all new construction permit applications (Pickens County Code of Ordinances Sec. 16-63). Permits expire 12 months from date of issue. Permit fees will be doubled if construction activity is undertaken prior to obtaining permits. Permits are Non-Transferable and Non- Refundable. Failure to schedule all required inspections will result in fines and/or stop work orders on the permit. ELECTRICAL ONLY PERMIT Date Applicant of Permit: Property Owner: Mailing Address: City State Zip Phone Number: Email: A COPY OF THE CONTRACTOR’S STATE, BUSINESS AND DRIVERS LICENSE IS REQUIRED WITH THIS FORM Electrician: Mailing Address: City State Zip Phone Number: Electrical State License Expiration Date: Business License Issuing County: 911 Address City State Zip Type of permit applying for: Utility Company: A.E.M.C. GA Power Current Zoning Use: (Circle) AG SA ER RR SR UR SPC SRPC NC HB I Is the property subject to any restrictive covenants or conditions? Y or N Is the property in an HOA? Y or N If yes, does your HOA require approval? Y or N Subdivision Lot Number Total Acres Directions to Property: Estimated Completion Date: Estimated Project Value: Signed Date: ANY ALTERATIONS, DEVIATIONS, RELOCATIONS, OR CHANGES TO THIS APPLICATION WILL VOID THIS PERMIT SIGN ---PAGE BREAK--- Updated 2/15/2023 For Office Use Only Parcel Number District and Land Lot Comments BUILDING PERMIT FEES ELECTRICAL ONLY PERMIT COMMERCIAL DATE PAID CASH/ CHECK/ CC# RECEIPT APPROVED BY DATE COMMENTS BUILDING PERMIT NUMBER Updated 2/17/2023 ---PAGE BREAK--- PICKENS COUNTY PLANNING & DEVELOPMNENT 1266 East Church Street, Suite 136, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] SUBCONTRACTOR AFFIDAVIT Power approval WILL NOT be released to your power company without this form on file with our office PRIOR to your electrical inspection. Building Permit Subdivision/Lot # Property Owner’s Name: Job Site Address: City State Zip Temporary Construction Power is hereby authorized on the electrical service conductors and service switch located at above mentioned address for a period of ninety (90) days. This request is made in order to complete construction of the final inspection at the above referenced location. An extension beyond the allotted time may be granted for good and sufficient reasons, provided the applicant gives notice before the expiration date, and subject to the Planning & Development’s approval. By applying for this temporary construction power permit, the applicant hereby assumes all responsibility and liability for use of electricity within the building during this period. NOTE: AN APPROVED FINAL INSPECTION AND CERTIFICATE OF OCCUPANCY IS NECESSARY BEFORE RESIDENCY IS ALLOWED. RESIDENTIAL OCCUPANCY IS NOT ALLOWED IN CONJUNCTION WITH TEMPORARY CONSTRUCTION POWER. FAILURE TO COMPLY WITH THE GUIDELINES SET WITHIN THIS PERMIT APPLICATION MAY RESULT IN IMMEDIATE DISCONNECTION OF ELECTRICAL SERVICE. VIOLATION OF COUNTY ORDINANCES MAY RESULT IN MAXIMUM FINE OF $1,000.00 AND SIXTY (60) DAYS IN JAIL, OR BOTH. Pickens County and its building inspectors are hereby relieved from any liability, damage, or loss associated with connection or disconnection of this temporary service. Print Name Signature (Required) Date Mailing Address City State Zip Current Phone Number (Required) Please indicate below the type of State License you hold and are using for this job Electrical Contractor Class I (Restricted to single-phase, not to exceed 200 amps) Electrical Contractor Class II (Unrestricted) A COPY OF YOUR STATE & BUSINESS LICENSE IS REQUIRED WITH THIS FORM AFFIDAVITS MUST BE SUBMITTED PRIOR TO SERVICE CONNECTION OR ROUGH INSPECTION REQUESTS. Electrical Contractor's Statement: The service equipment for the above referenced job location has been installed in accordance with all applicable state codes and county ordinances. In the event of any change in my status on this installation, I understand that I will be held responsible for this job until Planning and Development has been notified in writing of any changes. This is to certify that I am responsible for the electrical service on the above permit. Signature: Date: Please Print Name: County Business License Registered With: Business License Number: Expiration Date State License Number: Expiration Date Company Name: Company Street Address: City, State, Zip Code: Phone: Updated 2/17/2023