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FOR CITY V4M~[DATIOIsI_ I 285 C. hugh St NE, Room <br /> <br /> 24 Hr In~e~tlon Lin~ <br />Office: 588-5147 8:~ a.m. - 4:30 <br /> F~: 588-79~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Ploaso comploto all Sections, I through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />l PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT ] <br />STARTED wi'ri-liN 180 DAYS OF ISSUANCE OR IF <br /> l <br />WORK IS SUSPENDED FOR 180 DAYS, <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br />_r~!¢¢tma~ ce.tractor [ <br /> Mailing Address <br /> <br />Supeevi~or'a License No. { Phone <br />211. FOR OWNER INSTALLATION]S <br /> <br />oi,y,s. z, . ore ©-lo t <br /> <br /> 3, PLAN REVIEW SECTION <br /> <br />{Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Secfien 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 1~ <br /> <br />Date: <br /> b~U.. ILDIN G iNSPECTION <br />isrmed : <br /> <br /> FEE SCt~DU~ (Complete and enter total in A I below) <br /> <br />10~ ~q. fi. or leas $85.~ 4 <br /> <br /> $50.~ <br /> 2 <br /> 201 am~ to ~ amps $~.~ __ <br /> ~I amps ~ ~0 amps $1~.00 __ 2 <br /> <br /> R¢~nn¢ct only $~,00 <br /> <br /> 2~ amp~ or 1~ <br /> 201 amps to 400 ~ps $~.00 __ <br /> ~1 amps to ~0 am~ $~.00 ~ 2 <br /> <br /> u) ~e fee for brach <br /> ~ch branch cimuil $ <br /> b) ~e [~ for brunch ~imults <br /> <br /> Fimt brach girguit $35.00 <br /> ~h additional branoh *iiguit $ 2.~ <br /> <br /> Mi~llan~us (~vie~ ~ p~ N~ Include) <br /> ~gh pump or i~igation ci~l~ ~.00 2 <br /> ~ch si~{ or outline Ii,lEg ~.00 2 <br /> Signal ~i~uil(8) or a limited en~gy <br /> panel, alt~ution or exto~ion <br /> <br /> (~ required by ~/Idi~ O~c{bO <br /> <br /> ~elling Peanit ~bel <br /> <br />5. FEES <br /> A I. Enter total of feea from Sec, g4 <br /> A2. Add 5% surcharge 605 x Al) <br /> Subtotal <br /> <br /> B. Enter 23% of line A 1 tbr Plan R.~¥iew <br /> (Sec. 3), if requimd <br /> C, Investigation E¢¢ (ii'required) <br /> D, Reinsp¢¢tion E~e ($25.00) <br /> <br /> ,l-- TOTAL AMOUNT DU]~ <br /> Receipt NO, __~7 t'~ <br /> <br />$ J <br /> <br /> <br />