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1. LOCATION OF INSTALLATION <br /> <br />FOR OFFICE USE ONLY ] MARION COUNTY BUILDING INSPECTION <br /> I <br />Date: .~ - ,, ~ Pbeee 588-$147 8:00 am - 4:30pm <br /> <br /> r J4N $ I 1997 <br /> <br />EXPIRE IF WORK IS NOT ST~ ~]~,0 DAY~ O~ ]~3UANCE <br />OR/~ WORK IS ~ED I~ 180 DAYS. - <br /> <br />2A, CO~ INSTAIJ~TION ONLY <br /> <br />Contrac'.~sao~dRes. No. '"'Z.-fO O"'t ~. <br /> <br />2B. FOR OWN'E~ ,~STALLAT[ON$ <br /> <br />Mail~ng Add~ess <br /> <br />Th~ h.,~:at~oa is being nmd~ ~ pmFefly i own wMch is n~t intended for sale. <br /> <br />Own~s Signauu'e <br /> <br />3. PLAN REVIEW SECFION <br /> <br />We will pmvkle plan review service if yo~ complu~c S~on <br />5B and submit two (2) sets of plans and specfficatons wi~h <br /> <br /> Thh optional plan review pmgrnm doe~ not m~end the <br /> requked submission of lightiug power caloa~ms, <br /> and specifications wheu required by the Ote~on Structuntl <br /> spe~Jt,/C, ede, Chapte~ S~. <br /> <br />MC 15-34 11191 <br /> <br />lO00 sq. ft, or less $1~.00 4 <br />~j .~e~ee mete~ $15.00 , <br /> <br />B. Sefl4~s or Feeders ~oe~ not inlcude branch circuits, see ~ection ~) <br /> Installnfle~ Alterations et Rdoenflon /- ' ' <br /> <br /> $300.00 , ~ <br /> <br /> lnstalbtfon, Alta"often, ~ Rdocatlon <br /> 200 amps or less ~,35.00 2 <br /> 2 <br /> 2 <br /> Ove~ 600 amps or 10(X) vo~ <br /> <br /> New, AIt~'atlon~ o~ l~J. enMea Pea' Panel <br /> <br /> a) The fee f= Immch ~rcuits ,,~th <br /> <br /> ~-~, ~-,,,~ ~=~t "'z- ~, $2.0o <br /> ~2..oo <br /> <br /> b) 1'ne fe~ f~'bnach circus ~ <br /> Each additieaal b,zanch circoit $2.00 <br /> <br />F. Ls,eb addlflonnl lmpecflm <br /> over the a]lo~able h any c~ the <br /> <br /> Pack cf l0 ls~els ~ ~5.00 esch $50.00 <br />H. Other <br /> <br />~. FEES <br /> Al. ]~nter total of fees f-z~ma ~ee. #4 <br /> A2. Add $~, surduuge (.05 x Al) <br /> <br /> ~abtotal <br /> <br /> B. Eute~25~ of~neAl for Plan Review <br /> <br /> C. <br /> o. <br /> <br /> TOTAL A~OUNT DUE <br /> <br />s ~q.~,o <br /> <br />$ <br /> <br /> <br />