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FOR OFFICE USE ONLY <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />ELECTRICAL PERMIT APPLICATION <br />?/ease complete all Sections, I through 5 <br /> <br /> 1. LOCATION OFINS'TALLATION .~_ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLI~ AND <br />EXPIRE IF WORK I$ NOT STARTED W1TttIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mail, s Address [ Phone <br /> <br />City/$tat~ffJp <br /> <br />Ownees SlSnamm <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan mv~ew service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application, <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br /> 220'High Slleet NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7~04 <br /> FAX: 588-794~, ] <br /> <br />Date: <br /> mUlliON UOUN,fY <br />Issued by: U!LD!NG me~c~,,,,,, <br /> <br />4, FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number of Inspactinns p~r permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) Suml <br /> <br />1000 sq, fl, or less $8S,00 <br />Each additional 500 sq. ft. <br />or pot'fion thereof $1 $,00 <br />Lim/.t~l Energy $20.00 <br />Each Manufd Home or Modular <br />Dwelliag Sender or Feeder $40,00 __ <br /> <br /> B. Services or Fe~ders (Does not inleade branch ¢ircalts, see se¢l,ioa D) <br /> Installation, ARc, rations or Relocation <br /> $0.00 <br /> 201 amps to 400 amps <br /> 401 amps m 600 amps $ ~ 00.00 __ <br /> 601 amtl~' to 1000 amps $~30.00 __ <br /> Over 1000 amps or volts $800.00 __ <br /> Re, conneet only $40.00 __ <br /> <br /> C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amp~ or le$* SSS.00 __ <br /> 201 ~ps to 400 amps $40,00 __ <br /> 401 amps to 600 amps $$0,00 <br /> Over 600 amps or 1000 volta <br /> <br />D. Branch Ci~ults <br /> N~w, Alteration, or Extension Per Panel <br /> <br /> a) The fe~ for branch dmults with <br /> ou~ehage of ~ervice oe feeder fee <br /> <br /> Bach branch c. ir euit $2.00 <br /> <br /> b) The fcc for branch circuta without <br /> gJurcha~e of ~ervica or feeder fee <br /> <br /> First branch circuit $35,00 <br /> Each additional branch circuit $2.00 <br /> <br />E, Mlscdlaneous (Service or FetM~r Not InFluded) <br /> Bach l~mp or irrigation *itcI~ ~ $40,00 <br /> Bach sign or outline lighting __ $40,00 __ <br /> Signal circuS(s) or a limited energy <br /> ~ panel, altamtion or extension $~0,00 <br /> <br />lq E~eh additional InspocUon <br />over the allowable in any of the <br />above, per In~pectlon $35,00 <br /> <br />O. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each $50.00 <br /> (~old only to electrical contractors) <br /> <br />H. Other <br /> ( As recff;red by Bailding Official) <br /> <br />A L Enter total of fee~ from Sec. #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Bnter 25% o¢ hne Al for Plan Review <br /> (Se~. 3). if r~qinrexl <br />C- ~vestigatlon Fee Of required) <br />D, ReinspeeUon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />