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ELECTRICAL PERMrF APPLICATION
<br />Pease ~mp/ete a//Sect~ns, 1 through 5
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />22O High Stme{ NE
<br /> SaJern, Oregon 97301
<br />
<br /> Phone 58~5147 8::00 a,m,, - 4 ~30 p,,m,,
<br /> Code.A-Phone: ~8-7904 SITE #:
<br /> i FAX: 588-7948 Date:
<br /> Issued by:
<br />
<br />2A. CONTRACTOR INSTALLA"IION ONLY
<br />
<br />Mailing Address/,/,.~ ~,~
<br />
<br />License No,,
<br />
<br />Contract~,, No,, l Job No,,
<br />
<br />2& FOROWNERINSTALLA'IIONS
<br />Property Owner
<br />Mailing Address I Phone
<br />Clty/$~ate[Zip
<br />
<br />The Installation Is being made on property I own which is nm Intended for ~ale,
<br />
<br />3. PLAN REVIEW SEC'r~3N
<br /> Check apptepriate item and enter f~ in &~ction 58,
<br />
<br /> Connected Load oVer L~O amps (except single family dwellings)
<br /> Building system over 200 amps (ex~ept s[qgle family dwellings)
<br /> System Over 600 volts
<br />....... Building over 2 ste~es
<br />__ Building Over 10,000 square feet
<br />..... Oc~upent load over 300 persons
<br />-- Manufactured Dwelling Park/Reareafion Park
<br />__ Hazardous Locations
<br />
<br />Submit 2 s~s of plans wi~ any of the above,
<br />Temporary conel~uctlon sarvi~es do not apply,,
<br />
<br />MC 1ff.34 Rev. 7190
<br />
<br />Permit No,
<br />
<br />4. FEE SCHEDULE (Complete and enter total in A~ below)
<br />Number of Inspections per permit allewed
<br />
<br />A. Residential, $tegleor
<br />Multi-Family per dwelling unit
<br />($erv,~e/ncJuded)
<br /> 1500 ~, fl, or le~
<br />
<br /> E~h Mfg ~ or M~ular
<br /> Dwellin~or f~r
<br />
<br />B.
<br />
<br /> 100 ~ or ~
<br /> 101 ~ste ~ ~
<br />
<br /> ~1 a~ ~ 10~ ~
<br /> ~ 1~0 ~s or ~1~
<br /> R~nn~l Only
<br />
<br />C. Tem~m~
<br />
<br /> 200 a~ ~ le~
<br />
<br />~er ~ ~s or 10~ volta (S~ 4B)
<br />D, Bmn¢h Clmul~
<br />
<br /> One ~mult
<br /> Two ~ ~n ~i~
<br /> Ea~ ~d'l ~n cimul~ ar portion
<br />
<br />[ MIs~lleneous
<br />(~e~ ~ Feeder not ~ud~)
<br /> ~h ~ or irdga~on ~cle
<br /> ~h s~n or outilne lighting
<br /> Sign~ eimult(s) ar ~ ~mi~ enemy
<br /> ~el, aimm~on ar
<br />
<br />F. ~ch a~'l Ins~c~on
<br /> over the Nl~le in any of
<br /> · e ~e, per in~on
<br />
<br /> Pack of 10 I~ ~ $5,,~ ea~
<br />
<br />$85, 4
<br />$ 15,
<br />
<br />__$~5, 2
<br />$60. 2
<br />
<br /> $130. __ 2
<br /> $35, 2
<br />
<br /> $35.__ 2
<br />__ $ 5o,,, 2
<br />__ $ ts,, ~
<br />
<br />$36. 2
<br />
<br />A~, Enter total of fees fram Sec,
<br />A~, Add 5% surcharge (.q5 x AQ
<br />
<br />B,, Enter 25% of line A~ for Plan Review
<br /> (Sec, 3), if required
<br />C. Investigel~c~ Fee (if required)
<br />D. Reinspec~on Fee ($25,00)
<br />
<br />TOTAL AMOUNT DUE
<br />
<br />$ / -~.5-
<br />
<br />
<br />
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