Laserfiche WebLink
FOR CITY VALIDATIONI <br />Receivod by: <br />Date: <br /> <br />I li~b~NTI'Y'DEVSEI ,~IF CENTER <br />1111~'"285 Church St N: ~ 132 ..... <br /> <br /> Dme: <br /> ne 373-44~? ~ <br /> <br /> BUILDING I~ assu~ ~y: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cross StreedDirecflons'. ~'--~'/~d/~'"/~ ~/~-~ ~r <br /> <br />P~grs S~ ~ON-~.~NS~',SU~ A~ r~X~ ~WOP~ m Nor <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COI~rrRACTOR INSTALLATION ONLY <br /> <br />Property Owner <br /> <br />Contractor~ Licem~ No. <br /> <br />]obNo. <br /> <br />Contractor's Boa~ R~*~ No. <br /> <br />Signature of Supervising Electrichn <br /> <br />Supervisor's License No. <br /> <br />2B. FOR ORrNI~, INSTALLATIONS <br /> <br />MailingAddres~,a~r"~T'dd?'~'~//~'I Phon~ ~-~'~Zg <br /> <br />City/State/Zip <br /> <br />Owner's Signatm'~: <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 />4. FBB SCHEDULE (Complete and enter ~1 ~ A l below) <br />~. R~dd~nti~l Per Unit Nmnl~r °f lnspeeti°ns P~r Imrmit all°wed '~ <br /> <br />~eh addi6o~ 5~ sq. fl. <br /> <br />~eh ~ufae~ H~ or Mo~l~ <br /> <br />200 amps or le~s tt $50.00 ~,~ <br />201 mnp~ to 400 mnps $fi0.00 2 <br />401 amps to 600 amps $100,.00 2 <br />601 ampslo 1000amps $130.00 __2 <br /> <br /> 200 amps or less $35.00 2 <br /> 20 [ amps Io 40O ampa $40.00 __2 <br /> <br />b) ~ll~e fee for branch circuits ~without <br /> purchase of s~rvic~ or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.00 <br />$ 2.0O <br /> <br />cseelhneoua (5ztvicz ~r Fe~d~r Not <br />h p~p ~ i~gat~n cigle <br />ch si~ o~ ou~e <br /> Si~nl ckcuigs) or a l~ited cn~ <br /> <br /> ~er ~ allowable in ~y of ~g <br /> <br /> ~ck of 10 l~eb ~ $5,~ <br /> (sold only to electrgal c~act~s) <br /> H. 0~ <br /> (~ ~eq~i~ed by Bail~ O~ciM) <br /> <br />$35.00 <br /> <br /> sq. fl. x $.068 =__ <br />#of Lal~ls N/C <br /> <br />FEES <br />Al. Enter totalof fees from S~. ~4 <br />A2. Add 5% surcharg~ (.05 x Al) <br /> Subtotal <br /> <br />B, En~r 25% of line Al for Plan Review <br /> (Sec. 3), if requffed <br />C, Investigation Pe~ (if r~quired) <br />D. Reinspection Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />