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~.~-~-~-'~-~ - ~2..~ ~ ~'_~_~,--.~ ......... <br />MARION COUNTY BUILDING INSPECTION <br /> <br />: Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P~ase c~mp,~te a//gect~ns, I through 5 <br /> <br /> 220 High S~reet NE <br /> <br />Phoneme88-5147- 8:00-a_m, - 4.30 p.m. <br /> <br /> FAX: .588-7~18 , / <br /> ~' I~su&d by: <br /> <br />SITE ~,: Permit No,, <br /> <br />,4, FEE SCHEDULE (Complete and enter total in A1 below) <br />Number of Inspeoflon~ per permit allowed .... <br /> <br /> A. Reeldeetlel. Single or Item~ x Cost = Total <br /> Multi-Family per dwelling unit <br /> (Servlce lncluded) <br /> 1500 sq. fl. o~ tsss <br /> <br /> Eechedd'lsoosq fLorpo~on __ $ 15 __ <br /> Ea, oh Mfg.'d Home or Modular <br /> Dwelling ~.ervlon or feeder <br /> <br /> Servtoe/FeeRers <br /> Bre,~h C,/r.~/t~/ndudon) <br />Inatalladen, Altera Sons or Retoc~tion <br /> <br />Mailim~ Address <br /> <br />SupervJsor's Ll~enee No,, <br /> <br />OWNER ~STALLATIONS <br /> <br />Phone No. <br /> <br /> 10o amps or less <br /> 101 amps te 400 amps <br /> 401 amps te 600 amp~ <br /> 60t eteps to t000 amps <br /> Over 1000 amps or volts <br /> Reconnect Only <br /> <br />C. TemporsW Servlees/Feedem <br />In$~allstlon, Altem tion or Relocation <br />200 amps er less <br /> 201 amps te 400 amps <br /> 401 amps m 600 amps <br /> Over 600 amps or 1000 volts (See <br /> <br />D. Branch Circuits <br />New. Af~m~on or Ex~nston Per Panel <br />One cimuit <br /> Two to ten circuits <br /> Each add'l mn eimuits or pedion <br /> <br />E. Mlscallaneous <br />(~i~e ~ Feeder not included) <br /> Each pump or Irrigation cycJe <br /> Each sign or outline lighl~ng <br /> <br />~mpert'/Owner <br /> <br /> O('C c)'?,.3,J <br /> <br /> Signal circuit(s} or a Iimiled enen3y <br /> panel, almradon or extension <br /> <br />F, Each add'l Inspection <br /> over the allowable In any of <br /> ~he abOVea per inspecdon <br /> <br />G, Minor leetslleflon Labels <br /> Pa~k of 10 labels @ $5,,00 ea~h <br /> (Sold only to electrical contractors) <br /> <br />I.L Other <br /> (As requited by ~Jilding Of~dal) <br /> <br />__$60.__ <br />$80. <br />__ $130, __ <br />$300. <br /> <br />__$:35.__ <br /> <br /> $ 15 <br /> <br />2 <br />2 <br />2 <br />2 <br /> <br />2 <br /> <br />,3. PLAN REV1EW SECTION <br /> Check appropriate item and enter fee in Section 58. <br /> <br />__ Conne~Asd L~ad over 200 amps (except single family dwellings) <br />__ Building system over ~ amps (except single family dwellings) <br /> System over 600 votis <br /> Building ever 2 stories <br />__ Building over 10,000 squars feet <br />__ C~x~psnt load over 300 persons <br />__ Manufactured Dwelling Pa~k/~n Park <br /> Hazardous Locations <br /> <br />Submit 2 sets of plans with any of the above,, <br />Temporary cons~mfon services do not apply. <br /> <br />Al. Enter total of feee fram Se~. ~4 <br />A~. Add 5% surcha~e 605 x A~) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A~ for Plan Review <br /> (See,, 8). if required <br />C, Investigation Fee (if required) <br />D. ,Re[n{;pection~F~ ($25,00) <br /> ('~"~T~T DUE <br /> <br /> <br />