Fillable ELECTRICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland)

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ELECTRICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland)

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BROWSE CITY OF MIDLAND (MI) FORMS

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Page 1 of 2
ELECTRICAL PERMIT APPLICATION
CITY OF MIDLAND – BUILDING DEPARTMENT
333 W. ELLSWORTH ST., MIDLAND, MI 48640
989-837-3383
PROJECT ADDRESS __________________________________________________________________
OWNER __________________________________________________PHONE___________________
EMAIL ____________________________________________________________________________
CONTRACTOR INFORMATION
CONTRACTOR_____________________________________________PHONE____________________
CONTRACTOR ADDRESS ______________________________________________________________
CITY/STATE/ZIP______________________EMAIL__________________________________________
LICENSE # ________________________________________ EXPIRATION DATE __________________
CELL/ALT. PHONE _____________________________________ FAX # _________________________
___________________________________________________________________________________
HOMEOWNER AFFIDAVIT: (if permit is under homeowner’s name)
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 in or about to occupy. All work
shall be installed in accordance with the Michigan Building Code and shall not be
enclosed, covered up, or put into operation until it has been inspected and approved
by the City Electrical Inspector. I will cooperate with the City Electrical Inspector and
assume the responsibility to arrange for necessary inspections.
T
HIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180
DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ THIS APPLICATION AND ALL PROVISIONS OF LAWS AND
ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE
GRANTING OF A PERMIT DOES NOT GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SECTION 23a OF THE 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 RESIDENTIAL
STRUCTURE. VIOLATORS OF SECTION 23a ARE SUBJECTED TO CIVIL FINES.
SIGNATURE OF OWNER OR CONTRACTOR ________________________________________________________
(Homeowner signature indicates compliance with Homeowner Affidavit)
PRINTED NAME_________________________________________________DATE________________________
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Page 2 of 2
L
OCATION AND DESCRIPTION OF WORK: _________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
FEE SCHEDULE
***NEW Residential Construction (single family homes, duplexes, etc.) use square ft. of all floors
including garage, service, and temporary pole only.
PERMIT ITEM NO. FEE TOTAL
ANNUAL PERMIT (AS AUTHORIZED BY IBC SECTION 105.1.1) ______________ $1200.00 ______________
FIRE ALARM SYSTEM ______________ $50.00 ______________
MOTORS OVER 1 HP; NOT OVER 10 HP ______________ $6.00 ______________
MOTORS UP TO AND INCLUDING 1 HP ______________ $4.00 ______________
MOTORS OVER 10 HP; NOT OVER 50 HP ______________ $10.00 ______________
MOTORS OVER 100 HP ______________ $30.00 ______________
MOTORS OVER 50 HP; NOT OVER 100 HP ______________ $20.00 ______________
NEW CIRCUITS (INCLUDING SINGLE APPLIANCE ON 1 CIRCUIT) ______________ $4.00 ______________
ELECTRICAL OTHER (ANY CODE RELATED ITEM NOT LISTED ______________ $6.00 ______________
RESIDENTIAL NEW CONSTRUCTION PER SQUARE FT*** ______________ $.02 ______________
RECEPTACLES (1- 20) WHEN ADDED TO EXISTING CIRCUIT ______________ $10.00 ______________
RECEPTACLES OVER 20 (EACH) ______________ $.50 ______________
SERVICE REPAIR ______________ $8.00 ______________
SERVICE LESS THAN 100 AMPS ______________ $15.00 ______________
SERVICE 100 AMPS; NOT OVER 600 AMPS ______________ $25.00 ______________
SERVICE 600 AMPS; NOT OVER 800 AMPS ______________ $50.00 ______________
SERVICE OVER 800 AMPS ______________ $100.00 ______________
TEMPORARY POLE ______________ $15.00 ______________
CONTRACTOR’S LICENSE REGISTRATION (YEARLY) ______________ $15.00 ______________
BASIC PERMIT ISSUING FEE (ALWAYS APPLIES) $20.00
$20.00
Rev 10/20 TOTAL: ______________
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ELECTRICAL PERMIT APPLICATION CITY OF MIDLAND BUILDING DEPARTMENT (City of Midland)

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Completed 2 June 2021

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