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ELEC l t-{tCAL PERMIT APPUCATION <br /> P~a,~e con~e a~/E~;tJons, I thn3ugh 5 <br /> <br />1. LOCA~ON OE iNSTALLA~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High S~,~ NE <br /> Sa~m, Omgon 97301 <br /> <br /> Phone 588-5147 8:00 a m - 4..30 p m. <br /> <br /> Issued by:: <br /> <br />Job Address <br /> <br />D~ctlpIIon <br /> <br />lectrlcal Cent(actor <br /> <br />Confractor's Board R~o N Job No. <br /> <br /> ~ of Sup 'si c I~lan <br /> <br />Supervisor s License No phone No <br /> · ' / b 7 ?~ S I,, <br /> <br />2EL FOR OWNER iNStALLATIONS <br /> <br />Mailing Address I Phone <br /> <br />The inst~fl~tion i~ being made on proper['/I own which is not intended let sale, <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />(Sexy/ce .~duded) <br /> 1500 sq ft or less <br /> EaCh add"1500 SCl fL, or por~on <br /> <br /> 401 ~m't)~ to 600 amps <br /> 601 amps le 1 ooo an'~s <br /> <br /> Reconnect Only <br /> <br /> Over 5o0 amps or 1000 volts (see 4B) <br /> one circuit <br /> <br />E, Miscellaneous <br />(Service or Feedc~ not in~uded) <br /> Eash pump o~ Irrlga~on cycle <br /> Each sign or oulline lighting <br /> $ign;~l ~tn~,,lit (e) or a limited energy <br /> <br />F. Each edd'l th~pe~t~on <br /> over the allewet~e in any of <br /> ~e above, per inspection <br /> <br />(Sold on~y to electrical ~.c~ractors) <br />H. Other <br /> <br />$85. 4 <br />$ 15 <br /> <br />__ $60.__ 2 <br />$8o. 2 <br /> <br /> ~,3oo. 2 <br /> <br />$5o <br />__$15.__ <br /> <br />PLAN REVIEW SEC~O~ <br />Check app~priate item and enter f~e in Section <br /> <br />Connected Load over 200 amps (except single family dw~tling~) <br />BuBdmg system over 200 amps (except single family dwellings) <br />System over 6O0 volts <br />Build~ng over2 s~fies <br />B~ilding ovo~ 10,000 ~lUare feet <br /> <br />Hazardous LeeatJons <br /> <br />A~. Enter total of fees from Se~, ~ <br />A2, Add5% surcha~e (,05xA~) <br /> <br /> Bubtem~ <br /> <br />B Enter 25% of llne A~ f~ Plan Review <br /> (Sec. 3), if required <br />C, Invesllgali(x~ Fee Of required) <br />D Rdnr,~ec~on Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Submit 2 sets o! plans with any of the above, <br />Temporary consmJ~t~on sea, ices do not apply. <br /> <br /> <br />