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Page 1 of 2 Revised 7/2025 ELECTRICAL PERMIT APPLICATION CITY OF MIDLAND – BUILDING DEPARTMENT 333 W. ELLSWORTH ST., MIDLAND, MI 48640 [PHONE REDACTED] email: [EMAIL REDACTED] PROJECT ADDRESS OWNER EMAIL CONTRACTOR INFORMATION CONTRACTOR ADDRESS 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. THIS 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 SIGN ---PAGE BREAK--- Page 2 of 2 LOCATION AND DESCRIPTION OF WORK: FEE SCHEDULE ***NEW Residential Construction of single-family homes, duplexes, etc. mark fee for square ft. (all floors including garage and basement). As well as fees for service and temporary pole (if applicable). PERMIT ITEM NO. FEE TOTAL $1500.00 $53.00 $5.50 $7.50 $12.50 $26.50 $37.00 $10.50 $.06 $16.00 $.80 $10.50 $31.50 $53.00 $105.00 $21.00 $15.00 $53.00 $53.00 TOTAL: ANNUAL PERMIT (AS AUTHORIZED BY IBC SECTION 105.1.1) FIRE ALARM SYSTEM MOTORS UP TO AND INCLUDING 1 HP MOTORS OVER 1 HP; NOT OVER 10 HP MOTORS OVER 10 HP; NOT OVER 50 HP MOTORS OVER 50 HP; NOT OVER 100 HP MOTORS OVER 100 HP ELECTRICAL OTHER (ANY CODE RELATED ITEM NOT LISTED) (Quantity 1 for every 2 circuits) RESIDENTIAL NEW CONSTRUCTION PER SQUARE FT*** (Not applicable to additions, remodels, or renovations) RECEPTACLES 20) WHEN ADDED TO EXISTING CIRCUIT RECEPTACLES OVER 20 (EACH) SERVICE REPAIR SERVICE UNDER 600 AMPS SERVICE 600 AMPS; NOT OVER 800 AMPS SERVICE OVER 800 AMPS TEMPORARY POLE / TEMP SERVICE CONTRACTOR’S LICENSE REGISTRATION (YEARLY) BASIC PERMIT ISSUING FEE (ALWAYS APPLIES) Revised 7/2025 (Must be separate permit, fire alarms cannot be combined with general electrical permits.)