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IFOR OFFICE USE ONLY <br /> Received b~,: <br /> Dat~: <br /> <br /> MARION C(~UNTY BUILDING INSPECTION <br /> 220 High Slxect NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 ~a - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: $$S-7~4S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION Date: <br />Please complete all Sections, I through 5,J Issued by: <br /> <br />Permit No. <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-I~FUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED wrrFE[N 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPBNDED FOR 180 DAYS, <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> Ele~tr~calCootractor ~ ~_ ~ ~} Phone <br /> <br />............ f ~t <br /> <br /> C~ItacDt's B~ Rag. No. ~ ~ Job <br /> <br />2B. FOR OWNER INSTALL&TIONS <br />Property Owner <br />Mailing Address Phone <br />City/State/Zip <br /> <br />The installation is being made on prol~rty I own which is not intended for sale, <br /> <br />Owner% Slgnaturc ,, <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan rev/ow 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 />4, FEE SCHEDULE (Complete trod enter total in A1 below) <br /> Number tff Inspections per permit allowed --] <br /> <br />A. <br /> R~-~idential <br /> Per <br /> Unit <br /> / <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> 1000aqa, ft, or less $85.00 -- 4 <br /> Each acldifonal 500 sq, it. <br /> ot po~on thereof $15.00 <br /> L/m/ted Bnergy Sse.O0 -- 1 <br /> Each Manu£cl l-lome or Modular <br /> Dwelling Sex.ice or Feeder $40.00 __ g <br /> <br /> .50.00 <br /> 200 amps or le~s $ $~0.00 <br /> 201 amps [o 400 :Lmpa <br /> 401 amps to 600 ampa $100.00 <br /> 601 amips~to 1000 amlx~ $130.00 <br /> OVer I000 amps or volts SS00.O0 <br /> Reconnect only $40.00 <br /> <br /> C. Temporary Services/Feeders <br /> Installation~ AlteratJolb or Relocation <br /> 200 amps or less $35,00 <br /> 201 amps to 400 amps $40,00 <br /> 401 amtpss to 600 amps $80.00 <br /> Over 600 amps or 1000 voEs <br /> <br />D. Branch Circuits <br /> <br /> a) The fe~ for branch c~rct~ts with <br /> <br /> Each branch ci~uit $2,00 <br /> <br /> b) The f¢~ fcc branch drents without <br /> .pu~hase of scrvlce or feed¢~ <br /> <br /> F~ach additional branch circuit $2.00 <br /> <br />E. Mi$callaneous (Service or Feeder Nnt Included) <br /> Each pomp or irrigation circle __ $40.00 <br /> ~aeh sign or outline li~ghiln8 $40.00 <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or exwnsion $40,00 <br /> <br />F. Each additional lnsp~clion <br />over the allowable in any of the <br />above, per Inspection $$5,00 <br /> <br />G. Minor Installation Labels <br /> Pack of I0 labels @ $5,00 each $50.00 <br /> <br />H. Other <br /> (As required by Building Official) <br /> <br />5. FEES <br /> Al, Enter total of fee~ from Sec. #4 <br /> AZ Add 5% surcha~se (.05 x Al) <br /> <br /> Sub al <br /> <br /> B. En~r ~% of llne A 1 for Plan Review <br /> (S~, 3), if mqM~ <br /> C. hvest~ati~Fee (~ required) <br /> <br /> TOTAL AMOU~ DUE <br /> <br /> Reeq~pt No, <br /> <br /> <br />