Laserfiche WebLink
FOR CITY VALIDATION <br />Received by:, <br />Date: , <br /> <br />ELECTRICAL PERMIT APPLICATION[ ' <br />Ploaso comp/ete all Soctions, I through 5 "[ <br />1. LOCATION OF INSTALLATION <br /> <br />MAR[ON COUNTY BUILDING INSPECTION'~\ ~f.. ~-~ <br /> COMMUNITY DEVELOPMI~NT CENTER lyy/~-~ (~-~J~'~U""\ <br /> 285 Church St NE * Room 132 _~L[~~ ~ J~ / ~ ~ <br /> <br /> ~ Hr Ins~tio~ Line: 58~7~ DmO: d U L - ,~ ~55 C~ <br /> <br />PERMIT$ ARE NON-TRANsFERABLI~ AND EXPIRE iF WORK IS NOT <br />STAR~ ~THIN 1 ~ DAyS OF IS~UAN~ OR IF <br /> WO~ I~ 8~SPEND~D FO~ 150 DAYS. <br /> <br /> CO~RACTOR ~ST~LATION O~Y <br /> <br /> FOR OW~R ~ST~LATIONS <br /> <br />(pleas~ prim) <br /> <br />.] Phone <br /> <br /> Addrea8 <br /> <br />PLAN RnVIEW 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 />~ 15-.74 lv~Y4 <br /> <br />4. FF~F~ SCI'[EDLI'LI~ (Cmnplete and enter total hi A 1 below) <br /> <br />A, <br /> R~id~ntlal <br /> P~r <br /> Unit <br /> <br /> 10(K) ~q, fi, or less $85.00 4 <br /> <br />401 amps to 600 amps <br />601 aml~ Io 1000 maps <br /> <br />Installation, Altet~tlon, or Ruloeatlon <br />a) The l~* for bnlneh ~ireult~ ~jth <br /> <br /> $50.(X) ,2 <br /> $601×} ~-. 2 <br />Stoo.oo __2 <br />$130.00 -- 2 <br />$300.00 -- 2 <br />$40,O0 2 <br /> <br />$35.00 -- 2 <br />$40.00 -- 2 <br />SgO.(A) __ 2 <br /> <br />$ 2.00 -- <br /> <br />$35,00 <br /> 2.00 __. <br /> <br />Misaollaneoua (Service o~ F~I~r N~ Inoluded) <br />~eh pump or i~ation eimle ..... [ $~.00 ~ <br />Signal c~reuit(O or a limited cn~gy <br />panel, aliccolian or 0xtenfion $40.00 <br /> <br />Over thc allowable in any <br />a~v~, ~r [n~puctlon $35.~ ~ <br />Min~ Installation ~bol~ <br />]Pack of 10 labels ~ $5.~ ~ch $50.00 <br /> <br />(~ r*quired by Buildi~ OllMaO ..... <br /> <br />FEES <br />Al. Enter total of fees from Sec. #4 <br />A2, Add 5% surcharge (,05 x Al) <br /> Subtotal <br /> <br />B, Enter 25% of lina A 1 for Plan Review <br /> (Sec, 3), if required <br />C, lnvesfigaSon Fee (itrequi~d) <br />D. Rejl~peclion <br /> <br /> TOT~ ~OU~f DUE <br /> Receipt <br /> <br /> <br />