ELECTRICAL PERMIT APPLICATION …

1 City of Muskegon 933 Terrace St., Room 204 Muskegon, MI 49443 (231) 724-6715 Fax (231) 728-4371 ELECTRICAL PERMIT APPLICATION Date:_____ Job or Project #_____Permit #_____ I. JOB LOCATION Job Address Has a buil ding PERMIT been issued for this project? Yes No Not Required Name of Owner/Agent Owner Telephone II. CONTRACTOR/OWNER INFORMATION Contractor Homeowner Name License Number Expiration Date Address (Street & Name) City State MI Zip Code Telephone Number - Office Cell Phone Number Fax Number E- MAIL ADDRESS Contractor Information registered with the City of Muskegon?

2 Yes No (Must be renewed annually) III . TY PE OF JOBC lass of work (check all that apply) New Building Addition Alteration Repair Residential Commercial Industrial Other Description of work $ Include for all commercial when plans have been submitted. IV. FEE SCHEDULE Enter the number of items being installed. Multiply by the unit price for the total FEE INC. ONE INSPECTIONFEE#ITEMS TOTALFEE#ITEMS TOTAL1 Base Fee(non-refundable)12 Feeders (bus duct per 50ft)

3 $ Service/Subpanel upgrade thru 200 amp$ Mobile home park site$ Over 200 amp thru 600 amp$ Recreational vehicle park site$ Over 600 amp thru 800 amp$ KVA & HP each up to 20$ Over 800 amp thru 1200 amp$ KVA & HP each 21 to 50$ Over 1200 amp and GFI$ KVA & HP over 50$ POWER NOTIFICATION #18a Fire alarm up to 10 devices$ Fire alarm 11 to 20 devices$ #19 Fire alarm over 20 devices$ Circuits each$ Energy/Temp Controls, conduit or ground$ Lighting Fixtures per 25$ Inspections- Additional or Final$ Dishwasher$ Inspect Special/Safety$ ELECTRICAL Heating (baseboards)$ Hourly rate$ Furnace (unit heaters)$ Inspections, Underground$ Power outlets (inc.)

4 Range & dryers)$ Inspections, Meter$ Signs (units)$ Plan review fee*25%10 Signs (letters)$ *11 Signs (neon each 25ft)$ FEE:V. HOMEOWNER AFFIDAVIT AND SIGNATUREI hereby certify the ELECTRICAL work described on this PERMIT APPLICATION shall be installed by myself in my own home which I am living or am about to occupy. All work shall be installed in accordance with the ELECTRICAL code and shall not be enclosed, covered up or put into operation until it has been inspected and approved by the ELECTRICAL Inspector. I will cooperate with the ELECTRICAL Inspector and assume responsibility to arrange all necessary inspections.

5 Section 23a of the state construction code act of 1972, 1972 PA 230, MCL , prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or a residential structure. Violators of section 23a are subjected to civil fines. Signature of Licensee or Homeowner (Homeowner signature indicates compliance with Section V)Date