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OFRCE USEOM, Y <br /> <br />.................................... <br /> ........ <br /> <br /> LOCA'DON NSTAU.A'nON <br /> <br />Job Address <br /> <br />Electrical Oomractar <br /> <br />Mailing Address <br /> <br />Property Owrlet <br /> <br />Centtacter'e Li~ense Ne, <br /> <br />OontraGtar's Board Reg. No. <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />Sign&tufa 0f Supervls{ng Elec~lclan <br /> <br />Job No, <br /> <br />FOR OWNER i~E~TALLATIONS <br /> <br />The InstallAtion Is being made o0 property I own which Is not Intended for ~le, <br /> ~ner's Signature ~ <br /> <br />SITE ~: Permit No, <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br />Number of Insl~:tlona per permit allowed <br /> <br />A. Resldentlel. Slngleor It°ma x Cost = Total <br /> <br />Multi-Family pet dwelling unit <br /> <br /> 101~~ <br /> ~Ia~1~ <br /> R~nn~Only <br /> <br /> ~a~or~ <br /> ~l~sta~ <br /> ~er ~ ~ or 10~ ~ (8~ <br /> <br />D. Branch <br /> <br />E. Ml~llaneous <br />(~ ~ F~d~ ~t ~ud~ <br /> ~ ~ or irdga~n ~e <br /> ~h ~n or ou0ine lighang <br /> Sign~ cimuit(S) or a limit~ enemy <br /> <br />F. E~ ~d'l Ins~c~on <br /> ~r ~ ~l~le In any of <br /> <br />G. Minor ins~llaflon <br /> P~k 0f 10 ~eis ~ $5,~ each <br /> <br />~ $50. __ <br /> <br />2 <br /> <br />2 <br /> <br />2 <br /> <br />· . PLAN REVIEW 8EO11ON <br /> Gheck appropdata item and enter fee in Section SB. <br /> <br />Connected L~ad over 200 aml~ (ex~ept single family dwellings) <br />__ Building system over ~00 amps (ex,apt single family dwellings) <br />· ~yatem ever 6oo volts <br />__ Building ever 2 sto~s <br />.., Building over 10,00o square feet <br /> Occupant toad over ~00 persons <br /> Manufactured Dwelling Pafl~Recrea~on Park <br />~ Hazardous Locations <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary oonsm~tion servk~s do not apply. <br /> <br />Al, Enter total of fees from ~e~. <br />A~. Add 5% surcharge (.05 x <br /> <br /> Subtotal <br /> <br />B, Enter 2~% of line A1 k~' Plan Review <br /> (Sec. 3). if required <br />C. Inveatigatk~n Fee (if required) <br /> <br /> TOTAL AMOUNT 0UE <br /> <br /> <br />