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.................................... RECEIVED FOR C~[TY U~ ONLY ,.,~ 3150 ~t~ ~. ~ - Sui~ C ~R~d By: Da~: ~ S~, O~o~ ~305 ~ning By: Ci~: MAY 2S~:3~m 24 ~ Ins~Qon Line 373~2T F~ 588-7~8 R~ei~ 8: ~ount: $ ~ J .................................... - ~Aa~0N PEEMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF woRKIS SUSPENDED FOR I80 DAYS. City: State: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed Structure and will he my own g~neral contractor I understand that l must register as a construction contractor if the structure is sold or offered for sale before or ~pon completio~ lf l hire subcontractors, I wilt hire only subcontractors registered with the Construction Contractors Boarv~ If I change my mind and do hire a general contractor who is registered with the Construction Contractors Board. I will immediately notify Marion County of the name of the contractor. Owaer's signature: 3. PLAN RKVIEW SECtiON IMarion County does not require a pian review. We will In'ovide plan review service if you complete Section 5B and Submit two (2) sets of plans a~d specifications with this application~ MC 15-34 Rev 9/98 $2o.0o = s ssO.oo =$ $52,°° =s B. Services or Feeders (Does not inehid~ braaeh Circuits, see steam D) 200ampsorless -- x $65.00=$ , 2 201amps to 400 amps -- x $80.00=$__2 401 amps to 600 amps n $130.00 = $ 601 amps to 1000 amps -- x $170.00 -- $ 2 Over l~00 amps or volts -- x $390.00=$ 2 R~:0onect Oaly x $55.00=$ 200 amps e~ less -- x 201amps to 400 amps -- x $55.00=$__2 401 amps to 60O amps __ x $110.00=$ b) Thc fee f~ brauch ch~iis without thc E. Miscelioueo~s (~rvke o~ Feeder Not l~clud~l) Each Sign or Outline Lighting x $55.00 = $ 2 Signal Circuit(s) or a Limited Energy F. Eaeh additional Inspection above, l~r Inagection x $50.00 = $ G. Minor lmmll~tion Labet~ H. lnd~ri~l Plaint -- x $62,50/hr = OTHER, as requited by the Building Official $ TOTAL $ S. FEES Al. Enter total of fees fi-om Sec, A2. Add State Surcharge (.05% x Al) SUBTOTAL B, Enter 30% of llan Al for Plan Review C. Investigation Fee (if required) D. Reinspection Fee ($50.00) E. Addifio~xal Plan Review ($62.50/hr, minimum one-half hour) E Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one hour) G. Inspection Outside Normal Business Hoots, ($62.50/hr, minimum two hours) H. Indesuial Plant ($62.50/hr) TOTAL AMOUNT DUE $. $__ $~ $ $__