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FO C A~ N : <br />R~lv~by:/~'~~' :. ~c ~t~ / <br /> <br /> O~ce: Phone ~8~147 8:00am - 4:30pm ~]~I~' UU~Tv <br /> sss- s N <br />ELEG IGAL PERMIT APPLIGATION <br />~ o0mpl~t~ ~1 ~tion& ~ through 5 4. ~ ~ (~mplete and en~ total ~ A 1 bc~w) <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTle} ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~DF.D FOR 1 B0 DAYS. <br /> <br />2A. CONTRACTOR I~grALLATION ONLY <br /> <br />Signature of Supervising El~ctrichn <br />Supervisor's Licen~ No. <br /> <br />[ Phone~ <br /> <br />2B. FOR OWNER INST.aLI,ATIONS <br /> <br /> 3. PLANREVI~W 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 />MC 15-34 1/96 <br /> <br />A. Re~identlal Per Unit Nmnber of Inspections per perrait allowed -~ <br /> <br />1~ sq. fl. or less $85.~ 4 <br />~ch addi~onal 5ffi sq. ft. <br /> <br />Limited E~r~ $20.~ 1 <br />~ch Manufacmr~ Home or Modular <br /> <br /> ~ am~ or less $50.~ ~ 2 <br /> ~1 am~ to ~0 amps $~.~ ~ 2 <br /> <br /> ~1 ~ to 10~ ~ $1 ~0.~ ~ 2 <br /> Remnn~t only ~.~ ~ 2 <br /> <br /> 2~ m~ or le~ $35.~ ~ 2 <br /> <br />D. ~an~ Cir~its <br />a) ~e fee for brach c~ui~ ~ <br />~eh branch ei~uit $ 2.~ ~ <br /> <br />b) Thc tee for branch circuits without <br /> putclmae of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.~ <br />$2.00__ <br /> <br />B. Miscellaneous (~vi~ m' F~d~' No~ Included) <br />~ch p~p ~ ~gation clinic ~.~ 2 <br /> ~ch si~ or outline li~t~g ~.00 -- 2 <br /> Si~al cigui~s) or a l~ited en~ <br /> <br /> Over the allowablo in any of~e <br /> abovo, per ~pection $35,~ ~ <br /> <br /> Pack of l0 labels ~ $5.~ ~eh $50.~ ~ <br /> <br /> (~ r~thred by ~ildi~ O~ciaO ~ <br /> Amra Dwelling Electrical F~ q. fl. x $.068 = <br /> <br />5. FEB8 <br /> A 1. Enter total of fees lmm Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />~ubtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if r~luired <br /> C. Investigation Fee (if r~quired) <br /> D. Reimpection Fee ($25.00) <br /> <br /> 4J,~ TOTAL AMOUNT DUB <br /> Receipt No. ~ <br /> <br />16% 3fo4t2 ,6Z= IOr¢. cg <br /> <br /> <br />