Electrical Master Permit Log

This log is only for electrical work performed under the Electrical Master Permit program. This form is not to be used in conjunction with other permits, such as Building Permits, Facility Permits, or other Electrical Permits.

Which building was the work performed in?

This is the location inside the building (room number, area, department, etc.)

Last name of person performing the work.

First name of person performing the work.

Your company name:

Describe in detail the work performed.

Date the work was performed.

License number of person performing the work.

Enter your email address. This is used to send you confimation of log entry.

The phone number where we can reach you for questions.

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