Electrical
Inspection
TOWNSHIP
ELECTRICAL PERMIT LEE
Service
996 College Ave
Holland, MI 49423
616-396-1448
[email protected]
877 56th Street P.O. Box 427
Pullman, MI 49450
269-236-6485 Fax 269-236-6528
DATE:
_
PERMIT NO.
_
Job Location
_
TYPE OF JOB:
COMMERCIAL:
NEWD
REMODELD
_
RESIDENTIAL:
NEWD
REMODEL D
_
NEW SINGLE FAMILY DWELLING
SERVICE:
UPGRADE
D
Owner
~
Owner's Address
State
City
Zip
_
PERMANENTD
Phone No. (Home)
(Bus.)
_
ELECTRICAL PERMIT FEE SCHEDULE
Permit base fee, plus permit unit charge
Services through 200 amp
over 200 amp through 600 amp
over 600 amp through 800 amp
over 800 amp
Circuits
Lighting fIXtures per 25 and fraction thereof
Dishwasher, garbage disposal and·range hood. each
Furnace unit heaters
Electrical heating units (baseboards) each
Power outlets (including ranges, dryers, etc.), each (30 amp or more)
Signs, each
Feeders, bus ducts, etc. per 50 feet and fraction thereof
Mobile home park site
Recreational vehicle park site
K.V.A. & H.P.. (well pumps, A.C., etc.)
Fire alarms, up to 10 stations and horns
over 10 stations and horns. each
Inspections & Investigations. hourly rate
. Reinspection fee
Final Inspection
PER UNIT
NUMBER
FEE
40.00
15.00
1
40.00
20.00
30.00
40.00
5.00
5.00
7.00
Name of Power Co.
Energy Request No.
Date Ready to Inspect
--'--'-­
5.00
6.00
7.00
OFFICE USE ONLY
10.00
8.00
6.00
6.00
moo
50.00
100.00
48.00
40.00
40.00
TOTAL FEE
11 work is started before pennit is applied lor, an additional lee will be charged.
PAYMENT MADE TO: LEE TWP
TEMPORARyD
KEEP PINK COPY. RETURN OTHERS WITH PAYMENT
CONTRACTOR'S SIGNATURE
NAME
TELEPHONE NO.
ADDRESS
STATE
EXPIRATION DATE
LICENSE NO.
FEDERAL EMPLOYER ID NUMBER OR
REASON FOR EXEMPTION
IZIP CODE
I
"
WORKERS COMP INSURANCE CARRIER •
OR REASON FOR EXEMPTION
MESC EMPLOYER NUMBER OR REASON
FOR EXEMPTION
I
section 238 of the State ConstrucUon Codes Act of 1972, Act NO. 230 of Public Acts of 1972, being Section 125. 152a of the Michigan Complied Laws, prohibits a
person hom conspiring to circumvent the licensing requirements of this State relating to persons who perform work on residential building or residential struc­
lure. Violators of section 238 are subject to civil fines.
HOMEOWNERSARADAVrr
I hereby certify the electrical work described on this permit applicatlon shall be installed by myself in my own sirgle family dwelling in which I am living or about to occupy. All
work shall be installed in accordance with the Local Electrical COde and shall not be enclosed. covered up or put into operation until If has been inspected and approved by
the ElectrICal Inspector. I will cooperate with the Electrical Inspector and assume the responsibility to anange for necessary inspections.
SIGNED