Laserfiche WebLink
FOI{ CITY VALIDATION <br />Receivexlby: _ <br />Date: . <br /> <br />~~ING INSPECTION <br /> I~' J ~],~h,f'~l~ ~I~I~MENT CENTER <br />111%~ 28s ,Church'n~] ] Room 132 PERMIT NO' <br /> <br /> ~ Date: <br /> MAffinu~ctlon Line 3734427 <br /> ~ "~ffie~Y~8-5147 8:00am - 4:30pm <br /> BUILDING [~SpE~88-7948 Issu~ by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />1. LOCATION OF I/qSTALLATION <br /> <br />Cross S~dDir~dom: . <br /> <br />PERMITS APsE NON-TRaNSFERABLE AND Fe. XPIR~ IF WORK IS NOT <br />STARTED wrrHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR Ig0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Supervisor $ License No. / ~r~3~ I Ph0neg <br /> <br />FOR OWNER IlqSTALLATIONS <br /> <br />Property Owner (pin.print) <br />Mailing Addrez8 I Phone <br />City/State/Zip <br />Owner's Signature: <br /> <br />3. PLAN REVIEW 81{CTION <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. FEB $CHBDULR (Complete and enter total in Al below) <br /> <br /> Unit <br /> Sorvieo Included: Items COst (each) Sum <br />. 1000 soc fL or less -- $g5.00 4 · <br /> <br /> 2.01 amps to 400 aml~ $60.0~ 2 <br /> 401 amos to 600 amOs $100.00 -- 2 <br /> 601 amps IO 1000 amps $130.00 -- 2 <br /> <br /> 200 amps or leas $35,00 2 <br /> 201 amps to 400 amps $40.00 _ 2 <br /> <br /> a) The fee for branch circui~ ~ <br /> vurchase of service of feeder le~ <br /> Ea~h branch circuit ~.~ $ 2.00 ~ <br /> pglnCJ~se of service or feeder Fee <br /> <br /> E- Miscellaneous (Sorvic~ ~' Feeder Not Included) <br /> Each pump or {rtigatioa circle $40,00 __ 2 <br /> Each sign oroutline lighting $40.00 -- 2 <br /> Signal circuit(s) ora limited energy <br /> <br /> above, per Inspection $35.00 -- <br /> Pack of 10 labels @ $5.00 each $50,00 -- <br /> <br /> (As required by Building O~ciaO <br /> Dwelling permit Label # of Labels <br /> <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal $ -- <br /> <br /> (See. 3), if required $ <br /> D. Reimpection Fee ($25.00) <br /> TOTAL AMOUNT DUE <br /> <br />MC 15-34 1/96 <br /> <br /> <br />