Electrical Permit Application And Permit Form

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Electrical Permit Application and Permit # _____________________________________________
Authority: P.A. 230 of 1972 as Amended. COMPLETION IS MANDATORY PENALTY IS THAT PERMIT CANNOT BE ISSUED
JOB LOCATION INFORMATION:
I.
Name of Owner / Agent:
PLAN REVIEW REQUIRED
Address (Street Name & Number):
YES
NO
City
Township
II. CONTRACTOR / HOMEOWNER INFORMATION
STATE
EXPIRATION
Contractor
LICENSE #
DATE
Homeowner
Address (Street Name & Number)
State
Zip Code
Telephone
Email Address
Federal Employer ID
Fax
MESC#
Workers Compensation Insurance Carrier
State Registration Number / Expiration
Worker Order #
Local License Number / Expiration
III. TYPE OF JOB. Please
check appropriate boxes.
Single Family
Pre-manufactured Home
Alteration
Commercial
Industrial
New
HUD Mobile Home
Addition
Service Only
Other
IV. FEE SCHEDULE - Enter the number of items being installed, multiply by unit price.
FEE
ITEMS
TOTAL
FEE
ITEMS
TOTAL
KVA HP Wind Turbines, ***EVSE
1. Application Fee
1
$75.00
and *** PV Modules each
SERVICE
2. Thru 200
$10.00
$6.00
19. Units up to 20 KVA or HP/Per
3. Over 200 Amp thru 600 Amp
$15.00
PV Module
$6.00
4. Over 600 Amp thru 800 Amp
20. Mobile Home Park Site
$20.00
$6.00
5. Over 800 Amp thru 1200 Amp
21. Recreational Vehicle Park Site
$25.00
$4.00
6. Over 1200 Amp GFI only
22. Units up to 20 KVA. & HP
$50.00
$6.00
7. Circuits
23. Units 21 KVA to 50 KVA or HP
$5.00
$10.00
8. Lighting Fixtures – Per 25
24. Units 51 KVA or HP and over
$6.00
$12.00
9. Dishwasher
25. Smoke Detectors
$5.00
$5.00 ea
10. Furnace – Unit Heater
Fire Alarm Systems (not smoke
$5.00
11. Electric Heating Units
Detectors)
(baseboards)
26. Up to 10 Devices
$4.00
$50.00
12. Power Outlets (Ranges,
27. 11 to 20 Devices
$100.00
Dryers,Etc)
28. Over 20 Devices
$7.00
$5.00 ea
Data/Telecommunication Outlets.
SIGNS
13. Unit
29. Up to 10 Devices
$10.00
$50.00
14. Letter
30. 11 to 20 Devices
$15.00
$100.00
15. Neon – each 25 feet
31. Over 20 Devices
$20.00
$5.00 ea
16. Energy Retrofit – Temp. Control
32. Feeders-Bus Duct, etc per 50’
$45.00
$6.00
17. Conduit Only or Grounding Only
33. Additional Inspection
$45.00
$.75.00
18. Special/Safety Inspection
34. Final Inspection
$75.00
1
$75.00
(Includes Certification Fee)
35. Certification Fee
$50.00
$30.00
MAKE CHECKS PAYABLE TO DESIGNATED CITY OR TOWNSHIP
TOTAL FEES
$
Section 23a of the state construction code act of 1972, 1972 PA 230, MCL 125.1523A, 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 subject to civil fines.
V. APPLICANTS SIGNATURE
DATE
Signature of Licensee or Homeowner Indicates Compliance with Section VI Homeowners Affidavit
I hereby certify the electrical work described on this permit application shall be installed by myself in my own home in which I am living or 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 electrical inspector and assume the responsibility to arrange for necessary inspections.
PERMIT FEES PAYABLE TO DESIGNATED CITY OR TOWNSHIP

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