2. TOWNSHIP OF LENOX
   63775 Gratiot, Lenox, MI. 48050
   Phone No: 586/727-2085
   Fax No: 586/727-3188
4. Authority : 1972 PA 230
   Penalty: Failure to prvide information may result in denial of your request.
5. LARA is an equal opportunity employer/program. Auxilary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.
7. 1. Project or Facility Information
9. NAME OF OWNER / BUSINESS
10. Has a building permit been obtained for this project?

    ____ Yes    ____No    ____Not Required

12. STREET ADDRESS AND JOB LOCATION

    (Street Number and Name)

13. E-Mail
15. Phone:
16. Alternate Phone:
18. II. Applicant/Facility Contact Information
20. INDICATE WHO THE APPLICANT IS

    1. Contractor
    2. Homeowner
21. NAME OF HOMEOWNER / CONTRACTOR
23. STATE LICENSE NUMBER
24. EXPIRATION DATE
    EXPIRATION DATE
26. STATE REGISTRATION NUMBER
27. EXPIRATION DATE
    EXPIRATION DATE
29. ADDRESS
30. E-Mail
32. CITY
33. STATE/Zip Code
34. E-Mail
36. FEDERAL EMPLOYER ID NUMBER (or reason for exemption)
38. WORKERS COMPENSATION INSURANCE CARRIER (or reason for exemption)
40. III. Type of Job
42. TYPE OF JOB

    1. Single Family

    1. Other

    1. New

    1. Alteration
44. Job Description
46. IV. Plan Review Information
48. Plans must be submitted with an Application for Plan Examination and the appropriate deposit before a permit can be issued, except as listed below.
50. Plans are not required for the following: *See accompanying documentation

    1. When the electrical system rating does not exceed 400 amps and the building is not over 3,500 square feet in area.

    2. Work completed by a governmental subdivision or state agency costing less than $15,000.00.

    If work being performed is described above, check box below "Plans Not Required."

52. What is the rating of the service or feeder in ampere?
54. What is the building size in square footage?
56. Are Plans Required?

    1. Yes

    1. No
58. V. Applicant Signature
60. 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 subjected to civil fines.
62. SIGNATURE OF LICENSEE OR OWNER
63. DATE
    DATE
65. VI. Homeowner 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 Michigan Electrical Code and shall not be enclosed, covered up, or put into operation until it has been inspected and approved by the Local Electrical Inspector. I will cooperate with the Local Electrical Inspector and assume the responsibility to arrange for necessary inspections.

67. VII. Fee Schedule
69. Fee Chart: Item #6,

    Installing a site service in a park, the permit application must include the application fee, service, park site, and a final inspection.

71. 1. Contractor Registration
73. Fee
74. # Items
75. Total
77. 2. Application Fee
79. Fee
    $75.00
80. # Items
    1
81. Total
    $75.00
85. SERVICE
87. a. 200 Amps or less
89. Fee

    $15.00

90. # Items
91. Total
95. b. 201 - 600 Amps
97. Fee

    $25.00

98. # Items
99. Total
103. c. 601 - 800 Amps
105. Fee

     $30.00

106. # Items
107. Total
111. d. 801 - 1200 Amps
113. Fee

     $35.00

114. # Items
115. Total
119. e. Over 1200 Amp.
121. Fee
     $50.00
122. # Items
123. Total
127. 3. Circuits
129. Fee

     $5.00 each

130. # Items
131. Total
135. 8. Lighting Fixtures/Outlets - per 25
137. Fee

     $20.00

138. # Items
139. Total
143. Swimming Pools/Hot Tubs
145. a. Circuit and underground/Conduit Cable
147. Fee

     $50.00

148. # Items
149. Total
153. Data/ Telecommunications outlets
155. a. 1-19 devices
157. Fee

     $5.00 each

158. # Items
159. Total
161. b. 20-300 Devices
163. Fee

     $100.00

     
     

164. # Items
165. Total
167. c. Over 300 Devices
169. Fee

     $300.00

170. # Items
171. Total
175. MOTOR UNITS
177. a. Units up to 20 K.V.A. or H.P./Per PV Module
179. Fee

     $12.00

180. # Items
181. Total
183. b. Units 21 to 50 K.V.A. or H.P/Per PV Module
185. Fee

     $14.00

186. # Items
187. Total
189. c. Units > 50 K.V.A. or H.P/Per PV Module
191. Fee
     $20.00
192. # Items
193. Total
197. Fire Alarms
199. a. Up to 10 Devices
201. Fee

     $50.00

202. # Items
203. Total
205. b. 11 to 20 Devices
207. Fee

     $100.00

208. # Items
209. Total
211. c. Over 20 Devices
213. Fee

     $5.00

214. # Items
215. Total
217. d. Smoke Alarms (up to 5 units)
219. Fee

     $15.00

220. # Items
221. Total
225. Power Outlets
227. a. Dishwasher
229. Fee
     $10.00
230. # Items
231. Total
233. b. Water Heater
235. Fee

     $10.00

236. # Items
237. Total
239. c. Ranges/Dryer
241. Fee

     $10.00

242. # Items
243. Total
247. Signs
249. a. Unit
251. Fee

     $10.00

252. # Items
253. Total
255. b. Letter (Each)
257. Fee

     $15.00 ea.

258. # Items
259. Total
261. c. Neon (ea. 25 feet)
263. Fee

     $20.00

     
     

264. # Items
265. Total
269. 5. Feeders-Bus Ducts per 50
271. Fee

     $10.00

272. # Items
273. Total
275. 6. Mobile Home Park Site*
277. Fee

     $10.00

     
     

278. # Items
279. Total
281. 7. Furnace/A/C Reconnect
283. Fee

     $15.00

284. # Items
285. Total
289. Energy Management Temp Control
291. Energy Retrofit-Temp Control
293. Fee

     $45.00

294. # Items
295. Total
297. Devices - Energy Management
299. Fee

     $5.00

     
     

300. # Items
301. Total
303. Conduit or Grounding Only
305. Fee

     $45.00

306. # Items
307. Total
311. 8. Solar Panels
313. Fee

     $40.00

314. # Items
315. Total
317. 9. Generator
319. Fee

     $35.00

320. # Items
321. Total
323. INSPECTIONS
325. a. Special Inspection (vacant > 60 days)
327. Fee

     $100.00

328. # Items
329. Total
333. b. Rough/Additional Inspection
335. Fee
     $75.00
336. # Items
337. Total
341. c. Final Inspection
343. Fee

     $75.00

344. # Items
345. Total
349. d. Reinspection
351. Fee

     $75.00

352. # Items
353. Total
357. e. M/H community Inspection
359. Fee

     $25.00

360. # Items
361. Total
365. f. Underground inspection
367. Fee

     $75.00

     
     

368. # Items
369. Total
371. Total Fee*
373. Make Checks payable to "Lenox Township"
375. General:

     Electrical work shall not be started until the application for permit has been reviewed and issued by the Lenox Township Building Department. All work shall be in conformance with the State Electrical code.  No work shall be concealed until inspection has been completed.

377. Expiration of Permit:

     A permit will remain valid provided work is progressing and inspections are requested and conducted. A permit shall become invalid if the authorized work is not commenced within six months after issuance of the permit or if the authorized work is suspended or abandoned for a period of six months after the time of commencing the work.

     Closed permits cannot be refunded.  The cost to reopen a permit is $150.00.

379. Lenox Township will not discriminate against any individual or group based on race, gender, religion, age, national origin, color, marital status, disability or political beliefs.  If you require assistance with reading, writing, hearing, etc.  Under the Americans with Disabilities Act, you may make you needs known to this agency.

383. VALIDATION AREA
387. NEED COPY OF:
     DRIVERS LICENSE
     ELECTRICAL LICENSE
Leave This Blank:


389. 1. Receive an email copy of this form.
390. Email address

     This field is not part of the form submission.

391. Submit Submit and Print

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