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ELECTRJCAL PERMIT APPLICATION BUILDING[ <br />Please complete all Se~ion$, I ~krough 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br /> ts NOT ~ ~I~ leo DA Y$ OF I~ O~ IF <br /> ~0~ IS SUSPEND~ ~R 180 <br /> <br /> 2~ CO~OR ~FO~YION <br />I C~mor: ~U~I, IV~ ' S ~L~CTRIC CO. IN{ <br /> ~ai~in~a~ P. O. gOX 4~7 <br /> <br /> 0%': S TAYTON S~: OR Zip: 97383 <br /> <br /> ~: 769--7~24 <br /> <br /> 769-6114 <br /> <br /> C~ ~r4 No: 44344 <br /> <br /> C~ L~ No: 24-365C <br /> <br />Mailing <br /> <br />I am the PROPERTY OF, rN£R and own, reside in. or willretlde in the <br />completed jcructure and will be my own general contractor. I <br />understand that I mu~t register at a construction contractor ~c the <br />ztructure t$ $old or offered for Jale before or upo~* compleaon. If[ <br />hire subcontractors, t will hire o~ly tubcontractor$ registered with the <br />~Construction ConrractorJ Board. If l change my mind and do hire a <br />general co#tractor who i$ registered with the Con$truction <br />Contractors Board. I will immediately notify Marion County of the <br /> <br />~ Residential Per Unl~ ~lec lacludcd <br /> I~ C~ (~) Sum <br />I~St. FL ~1~ x $110.~ =$ 4 <br />~it~lS~,FL~ion~f -- x $20,~ <br />L~ ~ x $30.00= <br /> <br /> ~I~II~F~ x $52.~ = $ 2 <br /> <br />· ~lc~ or Feeden ~oes not include branch Clrcui~ ~e ~cfion D) [ <br /> <br />401~m~ ' x SI~O.O0~ S- 2 / <br />~ I~ ~ ~ vol~ x S390.~ = $ ~L~. - <br /> <br /> ~ Tem~o <br /> I~ ~temBon~ or Relocation <br /> 2~ . x $45.~ - $ 2 <br /> 201~ x $55.~- $ 2 <br /> 401 ~ x $110.~~ $ 2 <br /> <br /> D. Branch Cl~ul~ <br /> <br /> of S~im~F~F~.~BrC~ n $ 3.~ ~ $ <br /> <br /> F~ B~ C~it <br /> ~ ~it~l B~ C~uil <br /> ~ M~elhneo~ (~e or Feeder Not Included) <br /> <br /> Si~ Cml<s)m a L~ ~ ~1, <br /> Mmti~ ~ ~ <br /> F. ~h Addi~on~ Ins~eflon, ~er the allo~ble <br /> <br /> G. Minor Ins~l~6on <br /> <br /> (~ld ~y ~ ~1 Con~) <br /> H. Indns~l ~nt <br /> Oa~ FamH~ ~HM~ Fee: ~. F~ <br /> <br /> D~U~ Permit ~h (For ~a~le Fatuity D~agt Oaly) <br /> O~K~ ~ requital b~ t~t Buti~g O~dal ~ -- <br /> <br /> 50.00 == $ <br /> 3.00==$ <br /> <br /> 55.00 - $ 2 <br /> 55,~ "$ 2 <br /> <br /> 55,00 '~ $ 2 <br /> S 50.00 == $ <br /> $100.00= $ <br /> <br />$62.50 / hr = $ <br /> ,09 -$ <br /> <br />5. FEES <br />Al. Enter Total F~s from Sectio~t #4 <br />A2 Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL: <br /> <br />B. Enter 30% ot line A1 for Plan Review $ <br />C. Investigation F~, ifmluited S __ <br />D, ReinsI~ction F¢¢ (S50.00) S __ <br />E. Additional Plan Review (62.50/hr, <br />minimum onc-half hour) $ __ <br />F, Inspection for which no fee is specifically indicatexl, <br />($62.50/hr, minimum one hour) $ __ <br />O, Inspection Outside Normal Business Hours, <br />$62.50/hr, minimum two hours) $ __ <br />H. Indusa-ial Plant ($62.50/hour) [" <br /> totAL OUST s !,~ <br /> <br />MC 15-34 Re',' 9/98 <br /> <br /> <br />