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.................................... ~ r,s~uoN cot~,rr~ smt~q u~sPzc'nos <br /> <br /> FOR CITY USE ONLY ~ ~ [~i'~ 3150 ~150 ~ Df. NE -Su~C <br /> <br /> I' ~IiDIflM ~llhl' ~EDULEicom~etelndeatertot~llnAl~ <br /> <br />LOCATION OF INSTALLATION <br /> <br />PERMITX ARE NON- TRANSFE. RA~LE AND EXPIRE IF 14'OR~ <br />IS NOT gI'AR~ DT~IN 1S0 DA rs OF I~¢~Ud~ICE OR IF <br />WORK IS SUSPENDED FOR 180 DATSL <br /> <br />lA. CONTRACTOR INFORMATION <br /> <br />Si~mr¢ of,Su~i~ng El~ici,: <br />2~ FOR O~ER ~ON <br /> <br /> ~ ~ ~?eaae prmO <br /> <br /> Cib Sm~: Zip: <br /> <br /> I am the PROPER~ O~ER an~ own, re,Me ~, or will reset in the <br /> completed ;~uCture and will be my own general con.actor. [ <br /> underJ~and that I must regilter aJ a cozsff~ction con.actor ~ the <br /> l~ucrure t~ told or offered for zate before or u~n comptetWn. Ill <br /> <br /> Con~ucnon Con~actorJ B~rd. Ill change m~ mind and do hire a <br /> Con~actor$ B~rd. 1 will immediate~ noO~ Marion Co~n~ of the <br /> <br /> PL.A~ REVIEW SECT1ON <br /> <br />Maru)n Counvj do~ nOt r~quire a plan review. We will provide <br />plan review s~vic~ ifyo~ ~1~ S~ion 5B a~ sub~t ~ (2) <br /> <br /> :terns Cost {each) Sum <br />1000 St. FL or less x $110.00 =$ <br />E~eh Addit/m1500 Sq. Ft. or portio~ thereof <br />Limit~l Energy x $ 30.00 = $ <br />Ea l'd~u facm~:l H,m'~ o' <br />Modular Dv~llin$ Service or Feeder x $ $2.00 = <br /> <br />B. Services or Feeders (Docs not ioclude branch Circuits, ace Section D) <br /> l~tak~lion, Alteration, or Relocxtiou ,, <br />200 Imp~ or 1~ ~ x <br /> 65.0~ <br />201 ~r~ to400 ~mp~ x $ ~0.00 = <br />401 mr~s to 600 ~ml~ x $130.00= <br />6131 ~n~ lo ~000 ~r~ x 5170.00= <br />O~e~ 1000 ~mt~ o~ volts -- x 5390.00= <br />Reco~eet O~ly x 5 55.00 = <br /> <br /> 200 ~ o~ le~ x $45.00 ~ <br /> 201 ~ur~ to400 ~m~ x 555.00 = <br /> 401 m~l~ to 600 am~ x 5110.00 ~ <br /> <br /> D. Branch C'lreull~ <br /> New, Altcraflol~ or Eaten*ion Per Panel <br /> a) the fo~ fe~ bran~ circuits with tim vurcha~e <br /> of ~pti~ ~r F~xle~ Fe~. Ea B~ Ci~ <br /> b) TI~ f~ fo~ br~-h ci~uit~ w/lfieut thc <br /> <br /> Firat Brach Circuit x $ $0.00 <br /> F. zOa A&lifioml Bm'f& Cimait x <br /> E. Mlaezlhn¢on$ ($¢rvke or Feeder Not Included) <br /> Each lannp or irrigation drd¢ x $ 55.00 = <br /> Each Sign oc Ouflino Lightlng x 5 55.00 = <br /> $i~ Cimfit(s) o~ ~ Limit*t ~ <br /> Alte~tioa. oc Exlemio~ x 555.00= <br /> F. Each Additional Insp~ctioa, over the <br /> in 1ny of thc ~bove, per Iml~¢tion x <br /> G. Minor l~lstuliaflon Labtb <br /> Pa~ of 10 labdl ~ $ lO.00 etch x $1~0~00= $ <br /> (Sold ooly to EJccuictl C~tr~tors) <br /> H. lndustrhl Flint <br /> OndTv~ Fsmily Dweillug Fee: Sq. Fc~t x <br /> <br /> Dwtllllig permit Labeb (For Single Family Dw~ltings Only) <br /> OTHER, a~ required by the Building Officitl $ -- <br /> <br />TOTAL <br /> <br />5, FEES <br />Al. Enter To~nl Fees fiom Section #4 <br />A2 Add State Surch~ge (.1~% x Al ) <br /> <br />B. Enter 30% of ~te Al for Plan Review <br />C. Investigation F,e, if required <br />D. Reinsl~don Fee (550.00) <br />E. Additional Plan Review (62.S0/hr, <br />minimum one-half hour) 5. <br />F. Inspection for which no f~ is specifically indicated, <br />($62.50/h~, minimum one hoar) $ <br />G. ~.spection Outside Normal Business Hour~. <br />$62.50/hr, minimum tWO hours) $ <br />H. industrial Plant (S62.50/hour) <br /> TOTAL AMOUNT DUE $__ <br /> <br />MC 15-34 Rev 9,'98 <br /> <br /> <br />