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Received By: <br /> <br />Dala ...... <br /> <br />Electrical Firm: <br /> <br />Supervising Electrician; <br /> <br />ELECTRICAL, PERMIT APPLICATION <br /> <br />Phone: <br /> <br />Mailing Address: <br /> <br />Address: <br /> <br /> t Phone: Address; <br /> <br />Electrical Contractor~ No,; Home E~uilder~ Registration No.: <br /> <br />Supervising Use of Residential [] New [] Addition [] <br />Electrician's NO,: Building: Commercial [] Alteration [] Relocation [] <br /> <br />Occupancy <br />Change [] <br /> <br /> NO. RESIDENTIAL <br />__ Resldencewiring lessthan 1000 sq; ft ................................. @ $ 50,00 <br />,/ Residence wiring less than 20go sq, ft ................................. C~_$ 75.00 <br />__ Residence wiring over 2000 sq. ft .................................... @7 $ 105.00 <br />__ E~ectric heat installation in existing residence ........................... @ $ ;30,00 <br /> SERVICES <br />___ Temporary Construction Service ..................................... @ $ 30.00 <br />__ Service change onlyin an existing residence ........................... @ $ 30,00 <br /> Commercial or Industrial: <br />.... Service not over 100 amperes ....................................... @ $ 45.00 <br />__ Service ever 100 amperes but not more than 200 amperes ................. @ $ 70,00 <br />__ Serviceover200amperesbutnotmorethan400amperes ................. {'~.$ 100,00 <br />__ Service over 400 amperes but not more than 600 amperes ................. @ $ 150,00 <br />__ Sereiceover600amperes ......................................... @$ 200,00 <br />.... Service over 600 volts ............................................. @ $ 450,00 <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders: <br />__ Not more than 100 amperes ........................................ ~a; $ 25.00 <br /> Over 100 amperes but not more than 200 amperes ....................... @$ 40.00 <br />__ Over 200 amperes but not more than 400 amperes ....................... @? $ 70.00 <br />__ Over400amperes ............................................... @$ 85,00 <br />....... Feeder over 600 volts ............................................. (~$ 120.00 <br /> MISCELLANEOUS <br />__ A, EachtraJlercrmobilehomespace($ervlceeclulpment) .................. @ $ 25,00 <br />__ B, Each supply for mobile home (Connection) ........................... ~ $ 25,00 <br />..... C. EachirrJgationpump(Attachamapshowingloeafion) ..................... @$ 30.00 <br />__ D. Each electric sign or outline lighting ................................ @ $ 30,00 <br />__ E, Each swimming poct (bonding) ................................... ~q} $ 30,00 <br /> BRANCH CIRCUITS <br />__ Onenewcircuit;alteratloncrextension ............................... @$ 20.00 <br />-- Twoormorenawcircuits;slteratJonsorextensiona ....................... ~'q~$ 30,00 <br /> Other (as per NEC and Building Officlal) ......................................... <br />-- On-Site Technical Review (apply directly at Marion County only) ...................... <br />-- Industrial Plant Inspection (apply directly at Marion County only) ...................... <br /> Relnspection Fee ................................................ @ $ 20.00 <br /> FEE <br /> STATE SURCHARGE <br />Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> <br /> with the indicated fee, INVESTIGATION FEE <br /> FLEET SURCHARGE ~'~,~/ <br /> <br />$ CNATURE OF APP[,ICANT: ..... ~0~ NO <br /> <br /> HOMEOWNERS - I hereby certify that I am the owner of the property described above, at which location I propose to make an electrical installation for <br /> my own use and this property is not being constructed for sale, lease or rent. <br /> <br /> <br />