Electrical Application Form Part A - 8/2018 Page 1
BUILDING REGULATIONS DIVISION Office 937-225-4622 Visit our Website
451 W. Third Street, Dayton, OH 45422 Fax 937-225-6327 www.mcohio.org/build
ELECTRICAL APPLICATION FORM PART A
SUBMIT SEPARATE APPLICATIONS FOR EACH BUILDING, STRUCTURE, OR TENANT SPACE. PLEASE PRINT OR TYPE
1. PROJECT/BUILDING LOCATION
Project Name ___________________________________________________________
Street Address_____________________________________________________
Lot Number _____________________________
City________________________________________
Zip_________________
Parcel ID _______________________________
Subdivision_________________________________
Actual Jurisdiction (Township, Village, City)____________________________
2. BRIEF DESCRIPTION OF THE SCOPE OF WORK COVERED UNDER THIS APPLICATION
________________________________________________________________________________________________________
*If this permit application is connected to an existing building permit, what is that permit number?
BLD_______________________
3. SCOPE OF PROJECT
☐ New Building
☐ Building Addition
☐ New Building -Shell Only
☐ Alteration
☐ Repairs Only
4. TYPE
☐ Residential
☐ Commercial
Item
No.
Description
Fee Basis
Qty
Fee Due
☐
E.1
COMMERCIAL - New Service, Service Change, Alteration, Repair, or Upgrade, Temporary Pole
$175
☐
E.2
DWELLING UNIT - New Service, Service Alteration, Temporary Pole (includes 1
st
Meter)
$125
Additional Meters
$25 each
☐
E.3
EXISTING SINGLE FAMILY DWELLING UNITS - Service Change, Upgrade
$60
☐
E.4
Commercial Reconnect
$125
☐
E.5
Dwelling Unit Reconnect
$75
☐
E.6
All Other Electrical Inspections
$75
PLEASE REFER TO PAGE 2 FOR FEE DEFINITIONS & INSTRUCTIONS TOTAL:
Received by___________
Via: ☐ Main ☐ Office ☐ Fax ☐ Electronic
Amount Paid Up-Front_________
FOP_____________
Received date_________
Processed by______________
Date______________
Penalty Fee Due______________
Plans Approved by__________________________________
Date______________
Balance Due_________________
FOP_____________
5. BUILDING OWNER Contact Person____________ ________________________
Phone___________________________
Company Name_________________________________________
Email_____________________________________________
Address_______________________________________________
City, State Zip_________ _____________________
6. CONTRACTOR Contact Person__________ __________________________
Phone___________________________
Company Name_________________________________________
Email_____________________________________________
Address_______________________________________________
City, State Zip____________________ __________
7. APPLICANT Contact Person____________ ________________________
Phone___________________________
Company Name_________________________________________
Email_____________________________________________
Address_______________________________________________
City, State Zip________________ ______________
8. I HEREBY CERTIFY that I am the: ☐ Property Owner ☐ Agent for the Owner, and all information contained in this application is
true, accurate, and complete to the best of my knowledge. All official correspondence in connection with this application is to be sent
to my attention at the address above. I also understand that UP-FRONT FEES ARE NON-REFUNDABLE OR TRANSFERABLE.
SIGNATURE___________________________________________
PRINTED NAME___________________________________
$ 0
ELECTRICAL APPLICATION FORM PART A
APPLICATION INFORMATION AND INSTRUCTIONS
Electrical Application Form Part A - 8/2018 Page 2
The up-front fee is the minimum fee charged for each category, and is for all permit types requested. The up-front fee will be deducted
from the balance due and is non-refundable. Refund of fees will not be authorized if a permit cannot be issued due to code compliance
issues, cancellation of job for any reason, or non-awarded work.
Electrical permit fees are primarily assessed per the number of inspections requested or required. Fees must be paid prior to the
inspections; however, some exceptions may apply. No final inspection approval will be given until all fees have been paid in full.
For assistance in completing your application, contact the Building Regulations Division. Please refer to the Montgomery County
Building Regulations Division Fee Schedule Booklet for further details.
Item
No.
Description
Fee
1
Remarks
Number of Inspections
Included
ELECTRICAL FEE SCHEDULE EXCERPT
E.1
COMMERCIAL
- New Service, Service Change, Alteration,
Repair, or Upgrade, Temporary Pole
$175
Covers 1 inspection and release to the utility. Includes fault current
analysis review. Does not include multifamily dwelling units. For additional
inspections, see All Other Electrical Inspections.
1
E.2
DWELLING UNIT
- New Service, Service Alteration,
Temporary Pole
$125 base fee (includes 1st meter),
Plus $25 per meter
For single and multi-family dwellings. Covers 1 inspection and release to
the utility for up to four dwelling units in a single building. Additional
meters are an additional $25 per meter.
1
E.3
EXISTING SINGLE FAMILY DWELLING
UNITS
- Service Change, Upgrade
$60
For inspecting the repair of existing services in single family dwellings. This
fee covers one inspection of the service entrance equipment only, plus any
release to utility. For any other new work, see All Other Electrical
Inspections.
1
E.4
Commercial Reconnect
$125
Fee is per address. Includes 1 inspection and a release to the utility. Does
not include inspection of new work, or inspection of multi-family dwelling
units.
1
E.5
Dwelling Unit Reconnect
$75
For an electrical service safety inspection of single and multi-family
dwellings. Fee is per dwelling unit. Includes 1 inspection and a release to
the utility. Does not include inspection of new work
1
E.6
All Other Electrical Inspections
$75
Covers nominally 1/2 hour of inspection time. Includes alterations that do
not require a service release to 1 the utility
1
PERMIT TYPE
SINGLE FAMILY DWELLING AND ITS
ACCESSORY STRUCTURES
MULTI-FAMILY DWELLINGS OR
DWELLINGS ATTACHED TO ANY
COMMERCIAL USE
COMMERCIAL, INSTITUTIONAL,
AND INDUSTRIAL STRUCTURES
ELECTRICAL FEE SCHEDULE CLARIFICATION
What’s eligible?
This category is for single family homes and
structures that are accessory to the home
only.
This includes duplexes, tri-plexes, and any
other grouping together of dwellings with
other dwellings or with other commercial uses
All other forms of commercial (Ohio
Building Code regulated)
construction
New Services
$125
$125 Fee ($100 Base Fee, plus $25 1st meter),
plus $25 for each additional meter
$175
New Services and
temp pole on same
permit
$125 (includes 1st meter), plus $75 for temp
pole inspection ($225 min)
$125 Fee ($100 Base Fee, plus $25 1st meter),
plus $75 for temp pole inspection ($225 min)
$175 for new service,
$175 for temp pole ($350 min)
Service Changes,
Repairs and
Upgrades
$60, includes one inspection and release to
the utility. If additional electric work done
beyond the service, additional inspections
must paid for as well
$125 Fee ($100 Base Fee, plus $25 1st meter),
Note: When the repair/replace is for a “Meter Bank
Assembly” AND no other work is performed the
$125 Fee is charged for per assembly
$175
Temp Poles
(stand-alone permit)
$125 Base Fee (includes 1st meter),
plus $25 for each additional meter
$125 Fee ($100 Base Fee, plus $25 1st meter),
plus $25 for each additional meter
$175
Reconnects, where
no work is being
done
$75
$75
$125
Additional
Inspections
$75
$75
$75
