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FOR CITY VALIDATION[ <br />Received by: <br />Date: <br /> <br /> 24 hr. Inspection Line 37~427 <br />Omce: Phone 5~-5147 8:00am - 4:30pm <br />F~: ~7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dinmlom <br /> <br />PERIV~TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN [~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPEHDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Supervisor'sLice,eNo. ~,~.~ --I Phone -(~ ' <br /> <br />2B. FOR OWHER INSTALLATIONS <br /> <br />P~opmty Owner (pl~a ~ pdnt) <br /> <br />Mailing Addrgss I Phone <br /> <br />City/Slate/Zip <br /> <br />Own~'s Signature: <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 />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-$41/96 <br /> <br />200 amps or less $50.00 2 <br />201 amps 1o 4~0 amps $60.00 2 <br />401 amps to riO0 amps $100,00 __2 <br />601 naps to 1000 ~mps $130.00 . 2 <br /> <br />Reconnect only $40.00 ~ 2 <br /> <br />200 amps or less $35.00 2 <br />201 amps to 400 amps $40.00 2 <br />401 amps lo 600 amps $80.00 ~2 <br /> <br /> a) The fee for brsmch cimuits wilh <br /> <br />$ 2.0o <br /> <br />b) The tee for branch circuils wilhout <br /> <br />First bra~ch circuit $35.00 <br />Each additional branch circuit $ 2.00 <br /> <br />$35.O0 <br /> <br /> ,vq. fl. x $.068= <br /># of Labels <br /> <br />E. Miscellaneous (Se~viee or Fe~ler N~ Include) <br /> ~ch pump or ~gafion c~le <br /> ~ si~ or ou~e li~t~g <br /> Si~ ckc~t(s) ora ~it~ en~ <br /> <br /> ~er the allowable in ~y of~e <br /> a~ve, ~r ~pection <br />O. M~ In~aHati~ Lsbel~ <br /> Pack of 10 la~ <br /> (~d o~y to el*c~ical c~ractors) <br />H. ~h~ <br /> (~ ~quired by ~il~ O~c~/) <br /> <br />5. FEES Al. Enter total of tees flea Sec. <br /> A2. Add 5% surcharge $05 x Al) <br /> <br />Sebtotal <br /> <br />B, Enter 25% of line Al for Plan Reviow <br /> (Sec. 3), if r~quired <br />C. ]nv~stlgntion Fao Of required) <br />D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> R~ceipt No. <br /> <br /> <br />