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C~USEONLY <br />Received by: <br />Date: ," '-' <br /> <br />1. LC)CAllON OF INSTALLA'n(3N <br /> <br />Phone ,588~147 8.iX) ~m, - 4:30 p,m, <br />~ho~e: 588-79o4 <br /> FAX: 588-7948 <br /> <br />Issued by: <br /> <br />dobAddrea~ 8~ Hill ~t~.~e~ <br /> Detroit I Cress St, <br /> <br /> ~emove and reple~e,,,fu~e ~a~el <br />with a ~ew breaker panel. Six =ew circuits <br /> <br />2A. (X:N~,['[ZqAC'TOR ~AJ..LATK]N I~LY <br /> <br /> ,TTT~OHI ~ <br />MaJlingAddress 1390 13th St S <br /> <br />Proper[y Owner <br /> <br />Contra~tor'~ License NO, <br /> 24-18O <br />Contractor'~ 6card Rog. No. Job No. ~ I ~ ~ ~ <br /> ~6o~ I 14~1q6~ <br /> <br />Superviaor's Ll~nse No. <br /> <br />Prope'r~ Owner <br /> <br />M~Ji[ng Address I Phone <br /> <br />Ctly/StatalZIp <br /> <br />The Installation Is being made on properly I own which is not Intended for ~ale. <br />lease or rent. <br /> <br /> Owner's Signature <br /> <br /> .... Connected Load over 200 amps (except angle famib' <br /> eug~ng system ove~ a00 amps (except single family dwe~s) <br /> System Over 600 volts <br /> <br />~ Bull&ag Over2 slo~es <br /> guil~ng over 10,000 square feet <br /> O~upaot load over 300 persons <br /> <br />~ Manufac~md Dwelling Pad~Recma~m Park <br /> Hazmdous Locations <br /> <br />Submit 2 Set~ of plans with any of the above. <br />Temporary coes~t~l~on services do not apply. <br /> <br />4. FEE SCHEDULE (Comp, bm a~d enter to~ in At below) <br />Number ~f Inmpecliorm per permit allowed <br />A. Re~ldentla!r$!ngleor ~ Itame x (:o~t = Total <br /> <br />$ 15, <br /> <br /> 1 ~ ~. 35.09 <br />__$60 .......... <br /> <br /> $130. <br /> <br />__ $ 40..__ 2 <br /> <br />$3,5. 2 <br />$ 15, ~ 2 <br /> <br /> $3S, 2 <br />..... $~6,~ 2 <br /> <br />At. Enter total of fees from Sec. ~4 <br />;~, Ado S% surds'ge (,05x At) <br /> <br /> ~ubtotal <br /> <br />B :qter 25% of line At ~or Ph~n Review <br /> ~ 3), if r~lulred <br />C. ~, ~esligalion Fee (if required) <br />O. FlexOn Fee ($~oo) <br /> <br />TOTAL AMOUNT DUE <br /> <br />35.00 <br /> <br /> <br />