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Received By: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO. 225 <br /> 220 High Street NE ~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br /> Phone: Mailing Address: <br /> <br />Job Address; <br />Electrical Firm: ' /~ <br /> <br />Supervis.~.ng Electrician: . <br />Electrical Contras Or's NO,; O -' <br />S,pervisJ,g ~ Useof ~ <br /> <br />No, RESIDENTIAL <br /> <br />Site NO.: <br /> <br />Phone: <br /> <br />Cross Street: <br /> <br />Address; <br /> <br />Address; <br /> <br /> Home Builder's Registration No,; <br /> <br />Residential ~ New [] <br />Commercial "[]' A~teration ~ <br /> <br />Addition [] Occupancy <br />~etosatlon ~} Change [] <br /> <br />Residence wiring less than 1000 sq. ft ................................. @ $ 50,00 <br />.... Residence wiring less than 2000 scl, ft ................................. ~. $ 75.00 <br />Residence wiring over 2000 sq, ft .................................... @ $ 105.00 <br />..... Electric heat installation in existing residence ........................... @ $ 30.00 <br /> SERVICES <br />__ Temporary Construction Servlce ..................................... @ $ 30.00 <br />__ Service change only In an existing residence ........................... @ $ ,30.00 <br /> Commercial or Industrial: <br />__ Servicenotoverl00amperes ....................................... @$ 45,00 <br />..... ServiceoverlOOamperesbutnotmorethan2OOamperes ................. C¢$ 70.00 <br /> __ Service over 200 amperes but not more than 400 amperes ................. @ $ 100.00 <br /> <br /> __ Serviceover400amperesbutnctmorethan600amperes ................. @ $ 150,00 <br /> __ ServiceoYef6O0amperes ......................................... CC. $ 200.00 <br /> __ Serviceover600volts ............................................. @ $ 450,00 <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation el Alterations or Relocation of Distribution Feeders: <br /> __ Not more than 100amperes ........................................ @ $ 25,00 <br /> ____ Overl00amperesbutnotmorethan200amperes ....................... C~¢$ 40.00 <br /> Over 200 amperes but not more than 400 amperes ....................... @ $ 70,00 <br /> ........ @ver400amperes ............................................... @ $ 85.00 <br /> Feeder over 600 volts ............................................. @$ 120,00 <br /> MISCELLANEOUS <br /> __ A. Eachtrailarormobilebomespace($en/lceequipm~nt .................. @$ 25.00 <br /> __ E, Each supply for mobile home (Connection) ........................... @ $ 25,00 <br /> __ C. Each irrigation pump (Afl'ach e map showing Joc3tJon) ..................... (~ $ 30,00 <br /> ~, Eachelectricsignoroutl~nellghting ................................ ~?$ 30,00 <br /> __ E, Each swimming pool(bonding) ................................... @ $ 30.00 <br /> BRANCH CIRCUITS <br /> .~ One new circuit; alteration or extension ............................... C¢$ 20.00 <br /> ..... TwO or more new circuits; alterations or extensions ....................... @ $ 30.00 <br /> Other (as per NEC and Building Official) ......................................... <br /> · On- Site Technical Review (apply direcgy at Mad0n Coun~ only) ...................... <br /> Industrial Plant Inspection (apply directly at Marion County only) ...................... <br /> Reinspectton Fee ................................................ (,~ $ 20,00 <br /> FEE ~¢L~ - <br /> STATE SURCHARGE . . r- <br /> Please return COMPLETE APPLICATION pLAN REVIEW FEE <br /> with the indicated fee, INVESTIGATION FEE <br /> FLEET SURCHARGE <br /> TOTAL '$ <br /> <br />[] HOMEOWNERS - I hereby certify that I am the owner of the property described above, at which Ioa,~tion 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 />MC 15-34 <br />Rev. 12188 <br /> <br /> <br />