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Received By: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Blag. NO. 225 <br /> 220 High Street lie <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />3bAddress: ~ ,,~/~__~/¢~ 7,,~Site N°'; Or°ss Street: ....... <br />,, '" " <br />lectrical Firm,.~ / Phone; Address; .... <br /> <br />upervising Electrician: P h~o'n'~'; ..... ,~d're~'s: <br /> <br />'J'~ct rical Oontractor~ Ne,: Home Builder~ Registration NO.; <br /> <br />upervlsing Useof Resldedtial ~"'-~N ew [~ ' Addition [] Occupancy <br />lectriclen's No,: Building; Commercial [] I Alteration [] Relocation [] Change [] <br /> <br /> No, RESIDENTIAL <br />__ Residence wiring less then 1000 sq, ft ................................. @ $ <br />[ Residence wiring less than 2000 sq. ft ................................. @ $ <br />____ Residence wiring over 2ooo sq. ft .................................... @ $ <br />__ Electric heat installation in existing residence ........................... @ $ <br /> SERVICES <br />____ Temporary Constru~ion Service ..................................... @ $ <br />__ Service change only in en existing residence ........................... @ $ <br /> Commercial or Induetriah <br />__ Service not ever 100 amperes ....................................... @ $ <br />__ Service over 100 amperes but net mom then 200 amperes ................. @ $ <br />...... Service over 200 amperes but not more thaa 400 amperes ................. @ $ <br />..__ Service over 400 amperes but not more than 600 amperes ................. @ $ <br />__ Servlceover600amperes ......................................... @ $ <br />__ Service over 600 volts ............................................. @ $ <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders: <br />__ Not more than 100amperes ........................................ @ $ <br />__ Over l00 amperes but aot more than 200 amperes ....................... @ $ <br />__ Over200amperesbutnetmorethan400arnpems ....................... @ $ <br />__ Over 400 amperes ............................................... @ $ <br />__ Feederover600volts ............................................. @ $ <br /> MISCELLANEOUS <br />.__ A. EachtreJlerormobllehomespace(Se~vlceequlpment) .................. @$ <br />__ B, Eecilsupplyformobilehorne(Oonnection) ........................... @$ <br />__., C, Each irrigation pump (Attach a map showing location) ..................... @ $ <br />__ D. Each electdcsign oroutline lighting ................................ @ $ <br />__ E, Each swimming pool (bonding) ................................... @ $ <br /> BRANCH CIRCUITS <br />__ Onenewclrcuit;elterationorextension ............................... @$ 20,00 <br />__ Two or more newcircuits;alterationsor extensions ....................... @ $ 30,00 __ <br />__ Other (as per NEC and Building Official) ......................................... <br />__ On-Site Technical Revlew (apply directly et Marion County only) ...................... <br />__ IndustdalPlantlnspection(applydirectlyatMarionCountyonly) ...................... <br />__ Relnspection Fee ................................................ ('~ $ 20,00 <br /> FEE <br /> STATE SURCHARGE <br /> <br /> 50.00 <br /> 7~,00 <br />105.00 <br /> 30,00 <br /> <br /> 30.00 <br /> 30,00 <br /> <br />45,00 <br />70.00 <br />100,00 <br />150.00 <br />200.00 <br />450,00 <br /> <br />25.00 <br />40,00 <br />70,00 <br />85.00 <br />120.00 <br /> <br /> 25,00 <br /> 25.00 <br /> 30.00 <br /> 30,00 <br /> 30.00 <br /> <br /> Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> w'~th the indicated fee,' - INVESTIGATION FEE <br /> ,, FLEET SURCHARGE <br /> <br />~ HOMEOWNERS - I hereby ce~i~ that I am the owner of the proper~ described abo~, at which location I p~pose to make an electrical instelletlon for <br /> my own Use and this prope~y is not being constructed for sale, lease or rent. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />MC 15-34 (Oweer doing his own work) <br />Rev, 12/88 <br /> <br /> <br />