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~M~. RI'~I~C0UNTY BUILDING INSPECTION <br /> PERMIT APPLICATION <br /> <br /> SitusAddress:,_~ ~.~._' ~/~,~/~,~rV '" ~/~. ~ite~,~../ Cr6'ssStmet: <br /> ~ Phone: ~ Address; <br /> Electrical Firm: ~... .......... <br /> Supervising ElectrTcian: Phone: Address; <br /> <br /> Etectrical Contractor's No.: Home Bultder's R~istration No.; <br /> <br />"'Supervising Use of Ney,; [] Additbn [] Occupancy <br /> Electrician's NO.: Bultding: I Alteration [] Relocation [] Change [] <br /> <br />No,, <br /> <br /> RESIDENTIAL <br />__ Residencewlringlessthanlo00sq. ff ................................. @$ 30,00 <br /> Residencew[ringlessthan2000sq, ff, .. ~$ 50,00 <br />__ Residencewiringover2000sq. ft .................................... @ $ 70~00 <br />__ Electrlc heat installation in existing residence ............. .............. @ $ 20.00 <br /> SERVICES <br />__ Temporary Construction Service ................................... i, @ $ 20,00 <br />__ Servlcechangeoelyinaeexietingmeibence ........................... @$ g0.00 <br /> Commercial or InduStrial: <br />__ Servlcenotoverl00ampsres .............. . ...................... :. @$ 30.00 <br />__ Service over 100 amperes but not more than 200 amperes ............... @ $ 50.00 <br />__ Serviceover2OOamperesbutnotmorethan400amperes ...... :', ........ .'@$ 70;00 <br />__ Servlceovera00amporesbutnotm0rethan600amperes ................. @ $ 100.00 <br /> <br />__ Service over 600 amperes ......................................... @ $ 130,00 <br />__ Serviceover600volts ............................................ . @ $ 300;00 <br /> COMMERCIAL AND iNDUSTRIAL FEEDERS <br />· Installation of Alterations or Relocation of Dlstrtbuflon Feeders: <br />__ Not more than 100 amperes ........................................ @ $ 20.00 <br />__ Overl0oamperesbutnotmorethan200amporea ..................... ~, @$ 30.00 <br />__ Over200amperesbutnotmomthan40Oamperes ................ ....... @$ 50.00 <br />__ Over400empores ............................................. ~. @$ 60.00 <br />__ Feederover60Ovolts ............................................. @$ 80,00 <br /> MISCELLANEOUS <br />A, EachtrailarormoDilehomespacs(Serviceequiprnent) .................. @$ 20.00 <br />__ B. Eachsupplyformobilehome(Oonnection) . .......................... @$ 20,00 <br />__ C, Each irrigation pump (Attach & map showing location) ..................... @ $ 20,00 <br />__ D. Eachele~ricsignoroutlinelighting ................................ @$ 20,00 <br />__ E. Each residential swimming pool .................................. @ $ 20.00 <br /> BRANCH CIRCUITS <br />. One caw circuit; alteration or extension ............................... @$ 15,00 <br /> <br /> __ Twoormorenewcimuits;elteratioceorextensloes ....................... @$ 20,00 <br /> __ Other (as per NEC and Building Official) ......................................... <br /> __ On.Site Technical Review (apply directly at Marion County only) . ..................... <br /> __ Industrial Plant Inspection (apply directly at Marion County only) ...................... <br /> __ Reinspectlon Fee ....................................................... i~;~ <br /> STATE SURCHARGE ~'"~ ~ <br /> Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> with the indicated fee. INVESTIGATION FEE ~r ' / <br /> FLEET SURCHARGE , ~'-- <br /> <br /> HOMEOWNERS - I hereby certify that I am the owner Of the property described abeve, st which location I propose to ma~<e an electrical installation fOr <br /> my own use and this pro~rty is not being constructed for sale lease or rent. <br /> <br />MC 15-,3a /¥ ~-~ .... 7~'~.,' (Owner (t01ng NS own work) <br /> <br /> <br />