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FOR CITY VALIDATION <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNIYY DEYELOPMENT CENTER - '~ ~ ~ ~: <br /> <br />24. Hr Iesp~t/on Line: 5gib7904 <br />Office: 5gg-5147 8:00 a.m. - 4:30 p-m. <br />FAX: 5sg-7945 <br /> <br />ELECTRICAL PERMIT APPLICATION [ <br />P!.ea~o complete all Section,s, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />. ..-', .. <br /> <br /> P~M~$ A~ NON-~NS~BLE AND ~XPI~ IF WO~ IS N~ <br /> START~ ~ 1 ~ DAYS OF ISSUANCE OR IF <br /> WO~ iS SU$~ND~ FOR 180 DAYS. <br /> <br /> CONTRACTOR IlqSTALLATION ONLY <br /> ,. <br /> <br />Cofltr~ck}r'$ Board RcS. NO, [ Job No <br /> <br />Sigoat~c of Sup~mi~ing Electrici~ ~ <br /> <br /> 2B, FOR OWNI~R INSTALLATIONS <br /> <br /> City/S~t~p <br /> <br />3. PL~R~W SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review semce if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br /> .......... BUIkD}~IG <br /> <br />4. F~.]~ SCHF~DUL~. (Complete alxd e~xt~r ~ta[ in Al <br /> <br /> R~id~ntlal <br /> <br />201 amps m 400 mnp~ <br />40[ amp~, tO 600 aml~ <br />601 amp~ to 1000 <br /> <br />Installation, ~ation, ~ R~l~tion <br />2~ amps ot <br /> <br />~1 amos to ~0 amps <br /> <br />~) ~e fee for brach <br /> p~hase o~ice of <br /> <br />b) ~¢ fee for btangh ekouits wi~o~l <br /> <br />$35.00 .... 2 <br />$4o.oo ____ 2 <br />$80,00 2 <br /> <br />$ 2,00 --- <br /> <br />$35.00 <br />$ 2.00 <br /> <br />~ch pmnp or irrigalion cimle ~ $~.00 2 <br />~eh sigm or outline lighting $40.00 .... 2 <br />Signal *it0uit(a) or a lhnited energy <br /> <br />Pack of 10 labels ~ $5.(~) each <br /> <br />(~ required by Build/tLS O~ct~ <br /> <br />Aurora Dwelling Eleltfical F~ __~/./L x <br />Dwelling Permit Label # of L~bels <br /> <br />5, FEES Al. Enter total of £eea ffolll Sec. <br /> A2. Add 5% surcharge 605 x A D <br /> <br />~ubtota[ <br /> <br />B. Elliot25% of lineAl tbr Plan Review <br /> (See, 3), if required <br />C. Invlatigatloa Fee (if~quired) <br />D, Reinap¢¢tion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DU'~ <br />Rcecil,t No. -- <br /> <br />$_,, <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />