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MARION COUNTY BUILDING ~NSPECTIO~/~ COMMUNITY DEVEjLOPMENT CENTER <br /> F 285 Ch~ch St NE <br />FOR CITY V~ATION ' ~. <br />I <br /> <br /> ' ' <br /> F~: 588-~48 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> ............................................... ~ ......... , .... <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF wORK is NOT { <br /> I <br /> WO~ IS SU S~emND~ ~OR 180 DAYS. <br /> <br />2A. CONTRACTOR IlqSTALLATION oNLY <br /> <br />Contea~ior's Board Rmg, No, ~'O t~,, <br />Sisnal'uic ~f Supervi{ing El~u'i~ian ~ <br /> <br />lob No, <br /> <br />2B. FOR OWNllR INSTALLATIONS <br /> <br />Proj~rty Owner <br /> <br />Mailing Addreaa <br /> <br />Ci¥Stat~Z[p <br /> <br />Owm~r~8 Signature: <br /> <br />3. PLAN RBVIBW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />rifle I.~-.~4 12fl)4 <br /> <br />4. F]~]~ $CH]{~DU~.~ (C~nplcte and entcr total in A1 below) <br /> <br /> cc poetion fl,en~of 14 $15,fi,) ~,~ <br /> <br />200 amps or less $50,00 <br />201 ~,nps to ~)0 amps $~,~ <br /> <br />~1 slaps to 1000 amps $1~.00 <br />Owr 1~ amps or <br />Re~an~t only $~D0 <br /> <br /> lumtallatlon, ~t~at}on, ~ R~tion <br />~ ~pa or lc~ <br />~1 ~mps to ~ umps $~.~ <br /> <br />u) ~c f~¢ for br~h c~ui~ <br />~o~me of fe~ee~ <br />~eh branch ci~uR $ 2.~ <br /> <br />b) ~e i~ fcc branch ~i~uits wi~out <br /> <br />Fi~t brmch ~uit $35.~ <br />~h additional brach cimuii $ <br /> <br />Miscellaneous (S~vice cc P~l~e Not lneludM) <br />~¢h pump or imgation elsie ~.00 .2 <br /> <br />above, per lnagection $35.00 __ <br /> <br />(~ld only to electrlasl c~m*tors) <br />0~ <br />(~ reqnired by Boildi~ O~eiaO <br />Auwm Dwelli~ Electrical Fee ~. g. x $.~ = ~ <br /> <br />5, FEES <br /> A 1- Enter total of fees from S~, <br /> A2. Add 5% surcharge (,05 x A I) <br /> Subtotal <br /> <br /> B, ~ter 25% of line A 1 for Plan Review <br /> (~, 3), if r~ui~d <br /> C. Investigation gee (if required) <br /> D, Reinspe~tion Fee ($25,~) <br /> <br /> ~T~ ~OU~ DUE <br /> Receipt No. <br /> <br /> <br />