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I.' ELEC'rRICAL PERMIT APPLICATION <br /> Plaa~a =onlolete all Sect~ i fflrough 5 <br /> <br />1. LOC4t.~ON OF DIS"rAuLIkl~CIN <br /> <br />MARION COUNTY BUILDING IN t E N[, <br /> <br /> ~m: ~ SITE l: Permit No. <br /> ~KIUI~ bUUI~I ~ <br /> <br />~,. CONITU~'TOR ~I'ALL~'nON ONLY <br /> <br /> No. <br />IPho?"°- <br /> <br />I~'eotrical Contractor <br /> <br />Mailing Address <br /> <br />Property Owner <br /> <br />Contractor's Board Reg. Ne. <br /> <br />~'ignature of ~upervlslng Electrician <br /> <br />' Super~isot's License No. <br /> <br />P.B. FOR OWNER INSTAI..I.A~CiNS <br /> <br />Property Owner ~ ~'(/t <br /> <br />The [nstalletiofl is being made on property I own which Is not Intended for sale. <br /> <br />3. PLAN REVIEW SECTION <br /> Chec~k appropriate item and enter fee in Sec~on <br /> <br /> Connected Load OVer 200 amps (except single family dwellings) <br /> Bui~ng system over 200 amps (except single family dwellings) <br /> <br />~ System over 600 volts <br /> Building over 2 sleliac <br /> <br />~ Building over 10.000 ~uam feet <br /> <br />~ Occupant load over 30o persons <br />__ Manufactured Dwelling Park/Race,alien Pa~ <br /> Hazardous I.oca~ns <br /> <br />Submit 2 se~s of plans with any of the above. <br />Tempormy conslmotion servioes do not apflly. <br /> <br />4, FEE ~tCHEDULE (Complete and enter total in A~ below) <br />Number of In#pacUona per permit allowed <br /> <br />Multi-Family per dwelling unit <br /> <br /> 1500 sq, ft Or le~ <br /> Each a. dd'1500 sq. fl. or po~n <br /> Each Mfg.'d Home er Modular <br /> Dwelling service or feeder <br /> <br /> 101 aicpa ts 400 am~'~ <br /> 401 amps to 600 amps <br /> 601 amp~ ts 1000 amps <br /> Over 1000 amps er veils <br /> Reacnnec~ Only <br /> <br />C, Temporary <br />tnstalla~n, Ahera~ et <br /> 200 amp~ or le~ <br /> 201 ampsto 400 aml~ <br /> 401 amps to 600 amps <br /> <br />D. Bran=h Clrcult~ <br />New, AitaraS=n ~ Extse~on Per panel <br /> O~e <br /> Two ts ten drc~Jil~ <br /> Each edd'l ten =imults O~ podion <br /> <br />(S~rv~ ar Feeder r~ k~CfUdeci) <br /> Each pump or Ir~allon <br /> ~ach ~ign or outline ti~tlng <br /> Signal ¢lrcuit(~) or a limited <br /> <br />F. Each edd'l th~pe~don <br /> over the allowable In any of <br /> the above, per Inspe~on <br /> <br />G. Minor Inslella~oe Labels <br /> Pack o! 10 labels @ $5-00 each <br /> (Sold enO' to ale=rise/~-ontracto~) <br />H. Other <br /> (As required by Building <br /> <br />.... <br /> $15. <br /> <br />~ $130. ~ 2 <br />... $35. 2 <br /> <br />~$35, 2 <br />.,, $4o.~ 3 <br /> <br />~ $ ~5, ~ 2 <br /> $~0,~ 2 <br /> <br />,$36. 2 <br />~ $36.~ 2 <br /> <br />Al. Enter total of fees Dom Sec. <br />A~, AddS%surcharge (.0exAm) <br /> <br /> Subtotal <br /> <br />B, Enter 25% of line At for Plan Review (Sec. 3}, ff required <br />o.. · r u.. $ <br />o. Rel.speceo. Fee ($,~LO0) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />