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ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcel Owner: ~v~ ~_~ <br /> <br />Project Description: <br /> <br />PERli41TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR I80 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Progeny Owner: (p/ease print) <br /> <br />Mailing Address: <br /> <br /> City: State: Zip: <br /> <br /> ~ MARION COUNTY BUILDING INSPECTION <br />---. ..... ~111, 3150 Lancester Dr. NE - Suite C <br /> <br /> i'~ ~-;~ · - 4. FEE S~.~LE (complete and enter tot~ in Al) <br /> ' I~ Number of Inspections per permit ailowed <br /> MAFiION O[ ~dentialPer Unit Servl~lnchulad: <br /> 8UILDIN~ INS1 'Ei]b~lOl~. orl*,, ~ Cost (each) Sum <br /> -- x $1~0.00=$__4 <br /> Ench additional 500 ~q. ft. or pordon thereof -- x $20.00 = $ __ <br /> LimimdEne~gy -- x $30.00=$__1 <br /> <br /> Modular Dwelling S~vice or Feeder __ x $52.00 = $ -- 2 <br /> B. Ser~i~ or ~eader~ (Do~ no~ Ind~d~ hra~eh Cir~ult~ se~ zt~ilon D) <br /> <br /> 200 amps or les~ __ x $65.00 = $ -- 2 <br /> 201amps to 400 ~ps __ x $80.00=$__2 <br /> 401 ampsto600amps -- x $1~0.00 =$__2 <br /> 601 amps to 1000 ~nl~ -- x $170.00 = $__ 2 <br /> <br /> Imt~on, AEnr~om, or Ealee. aflon <br /> <br /> 401 amps lo dOO amps -- x $110.00=$ 2 <br /> Ove~ 600 amps ~ 1000 volts se~ "B" above <br /> <br /> a) The fe~ for branch circuits with the <br /> Each branch circuit -~ x $3.00 = $ <br /> b) TI~ fee f~ branch circuits without the <br /> <br /> Elr~ brach circuit -- x $50.00 = $ <br /> <br /> Eochpumporinigafionc/rcle -- x $55.00=$__2 <br /> EachSignorOutlineLigtainS __ x $55.00=$__2 <br /> Signal Circuit(s) ~r a Limited Energy <br /> Panel. Alteration or FAtension __ x $55.00 = $ -- 2 <br /> F. Each additional lmgection <br /> over the allowable in any of the <br /> abow, per inspection __ x $$0.00 = $_ <br /> G. Minor ImtaEnflan ~ <br /> Pock of 10 labels @$10.00 each __ x $100.00 = $ -- <br /> ~ (Sold only to Electrical Contractors) <br /> IL Industrial Plant -- x $62.50/hr = $- <br /> One/FwoFamilyDw~F~:Sq. Fea -- x $ .09=$__ <br /> Dwelling Enrmlt Labels (For Single Enmlly Dwellings Only) <br /> <br /> s 9~.oo <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the comp/etad structure and will be my own general contracto~ 1 <br />understand that I rnu~t register a~ a construction contractor ~f the <br />structure is sold or offered for sale before or upon completimt lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors BoanL If l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Boar~ I will immediately not~y Marion County of the <br />name of the contractor. <br /> <br />Owner's Sisnature: <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan r~vi~w. We will provide plan [ <br /> review service if you complete Section 5B and subm/t two (2) sets of <br /> plans and specifications with this apl) ication. <br /> <br />MC 15-34 Rev 9/98 <br /> <br />Al. Enter total of fees from Sec. g4 <br />A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($50.~0) <br />E, Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br />F. Inspection for which no fee is specifically indicated. <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Bu<mess Hours, <br /> ($62.50/hr, minimum two hours) <br />H. lndusUial Plato ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br /> <br />$/Of, <br /> <br /> <br />