Electrical Permit Application

Type of Work

RESIDENTIAL (single ownership residence). This includes modular homes, manufactured homes, travel trailers, also duplex, tri-plex and four-plexes. Construction and axtensive remodeling and additions to.

Square footage (based on enclosed living area:)___________$_________________

ALL OTHER FEES: (except for inspection in mobile homes and travel trailer parks) shall be computed on the dollar value of the electrical installation, including fixtures and installation costs thereof.

Valuation of work (actual costs to customer): $_____________________________

Mobile Homes and Travel Parks (Per Space) $_______________________________

Temporary Power Permit $______________________________

Transfer Permit $_____________________________________

THE PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZATION IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE ORR CANCEL THE PROVISION OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PREFORMANCE OF CONSTRUCTION. By signing below, I declare, under penalty of perjury in the second degree, that this application has been examined by me. That the statements made herein are made in good faith pursuant to the Town of Gypsum’s Municipal Code, and to the best of my knowledge and belief, are true, correct, and complete. I am attesting that the above listed business is in compliance with all laws of the United States, State of Colorado, and the Town of Gypsum. Also that this business or applicant is not in default of any financial obligation in any manner to the Town except current taxes. I also agree this business will comply with all laws and regulations applicable to such licensed business and avoid all practices or conditions which do or may affect the public health, morals, or welfare. In addition, this licensed business will refrain from operating upon expiration or suspension of this license unless renewed. This business license will be posted and maintained upon the premises in a place where it may be seen at all times.