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FOR CITY USE ONLY ~/'~ * Zoning By: ~_2.~Cit y ',~~ Receipt ~. ~Amount: $,_~,~ ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALLATION Parcel ID: parcel Owner: Cross Stre~ffDirections: PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTQR INFORMATION Mailing Add~ss: Supervisor License No.: Signature of Supervising Electrician: 2B. FOR OWNER INSTALLATI N ~-~ I am the PROPERTY OWNER and owt~ reside in, or will reside in the compkned structure and will be my own general contractor. 1 understand that I mu~t register as a construction contractor if the structure is sold or offered for sale before or upon completion, lf l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. Ill change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately notify Maffon County of the name of the contractor. 3. PLAN REVIEW SECTION IMarion County does not require a plan review. We will provide plan I review service if you complete Section 5B and submit two (2) sets of I plans and specifications with this apptica~on. I I MC 15-34 Rev 9/98 ~[ MARION COUNTY BUILDI~IG INSPECTION FaN 3150 Lancaster Dr. NE - Suite C ~l~lSam - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 . FE~iSCHEDULE (complete and enter total in Al) ~*'a~]l~ela~al~*~-~'~* Per Unit Servl.Number of Inspections per p~rmit ellowod --included: x $110.00 = $ 4 Each additional 500 sq. ft. or portion thereof -- x $20.00 = $ / sao.00: Each Manufactured Home or Modular Dwelling Service or Feeder -- x $52.00 = $ -- 2 B. Servic~ or F~l~m ~ not include branch Clrmlts, s~ s~c~on ?) ln~Inllaflon, AIt~rnlion or Relocation 200 amps or l~ss __ x $65.00 = $ -- 2 201 amps to 400 amps x $80.00=$__2 401amps to 600 amps __ x $130.00=$__2 601 ampsto 1000amps -- x $170.00 =$__2 Over 1000 amps or volts -- x $390.00 = $ --2 Reconnect Only __ x $55.00 = $__ 2 Immllatlon, Alterations, or R~ocation_ 200 amps or less ' __ x $45.00=$__2 201amps to 400 amps __ x $55.00=$__.2 401 amps to 600 amps -- x $110.00:$__.2 Ov~ 600 amps or 1000 volts se~ ~B' above D. Branch Clrtntits New ARea-ation, or Ex,talon P~r Panel a) The f~e for branch circuits with the Each branch circuit -- x $3.00 = $ b) The f~ for b~an~h ckcnlts without tim First branch circuit x $5000 -- $ ~'~ Each pump or irrigation circle -- x $55.00 = $ 2 Each Sign or Outline Lighting -- x $55.00 = $ 2 Signal Circ~t(s) or a Limil~l Enemy Panel, AltetatldnfftExteasion -- x $55.00=$__2 F. Each additional lnspeetian over the allowable in any of lite abev~, per impeetlon __ x $50.00 = $ -- G. Minor Installation Labels Packof 101abels ~$10.00eaeh -- x $100.00 =$__ (Sold only to Ele~Uieel Con~'aemrs) H. IndusOInlPlant -- x$62.50tht--$__ OmtTwoltamllyDw~F~:Sq. Feet -- x $ .09=$__ Dwelling Permit Lal~ls (For ~lingle ~ Dwellings Only) OTHEI?, as required by the Bnlldth~ Official $ -- FEES Al. Enter Wtal of fees from Sec. ~4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line Al for Plan Review C. Investigation Fee (if required) D. Reinspeclion Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) $ E Inspection for which no fee is specifically indic~l, ($62.50/hr, minimum one hour) $. -- ~. Inspection Outside Normal Business Hours, ($62.50thr, minimum two hours) $.__ H. Industrial Plant ($62.50gar) $~ ~' TOTAL AMOUNT DUE $ $ ~