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.... MARION COUNTY BUILDING INSPECTION ,~ ~-'Ll~ffllv'
<br />FOR OFFICE USE ONLY ~ ~ E,-r( ; , _ _, t ,
<br /> . . 220 I-Iigh Street NE , [~, ~' ~,. (v'~ ·
<br /> . Ph~c 588-5147 8:~ ~- 4:3~ .~ ~ d t~~ ~
<br />
<br /> ELEGTH CAE PE ~M TAPPE CAT ON ~.~ l~e: ,, ,,,,, ~c~ ':~
<br /> plans° oomploto all Soctioas, 1 throve5 1 9.-
<br />
<br /> LOCATION OF iNStALLATION
<br />
<br />PB~ ARE NON-~ANS~RABLE ~D NON-~NDAB~ ~D
<br />~X~ ~ WORK IS NOT STARTED ~ 180 DAYS OF ~SU~CE
<br />OR ~ WO~ IS S USP~D~ FOR 1 g0 DAY~,
<br />
<br />gA. CONTRACTOR INSTALLATION ONLY
<br />
<br />Property Owner Phone
<br />Con~ae~fs ~c~se No. · '~
<br />Co~trae~is Board R~g, No, ~ ~ ~ lob
<br />
<br />Signature ofSu~is~g El~tfiei~ ~ ~ ~
<br />
<br />FOR OWNER INSTALLATIONS
<br />
<br />Property Owner
<br />
<br />Mailing Address Phone
<br />
<br />City/St ate~glp
<br />
<br />The installation is being made on property I own which ii not intended for sale,
<br />
<br />Owner's Signatuie
<br />
<br /> PLAN REVIEW SECTION
<br />
<br />We will provide plan review service if you complete Section
<br />5B anti submit two (2) sets of plans anti 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 15434 11/91
<br />
<br /> Number of lnspcmtlons per permit allowed ~]
<br />
<br />A.
<br /> Residenttal
<br /> Per
<br /> Unit
<br /> 1
<br /> Service Included: lt~nS COSt (each) Sum/
<br /> 1000 sq, B. or less $85.00 -- 4
<br /> Each additional 500 sq. ft.
<br /> ornolrfic~ tbemof $ ~ fi.00
<br /> LJmjtec~ Energy $20.00 -- 1
<br /> Each Manufd Home or Mtxlular
<br /> Dwelling Service or Feeder $40.00 __ 2
<br />
<br />B. Services or Feeders (Does not inleude branch circuits, see section D)
<br />
<br /> Installation, Alterations or Relocation
<br /> 200 amps or less
<br /> 201 amps to 400 amps
<br /> 401 amps Io 600 ,amps
<br /> 601 amtps~to 1000 amps
<br /> Over 1000 mnps or ones
<br /> Reconnect caly
<br />
<br />C, Temporary Services/Feeders
<br /> Installation, Alto-ation, or Relocation
<br /> 200 amps or less
<br /> 201 amps to 400 amps
<br /> 401 amps to 600 amps
<br /> Over 600 amps or 1000 volts
<br />
<br />D- Branch Circuits
<br /> New, Alteration, or ~tan$1on Per Panel
<br />
<br /> a) Thc fee for branch circuits w~th
<br /> purchase of scr~ce or leader fee
<br />
<br /> Each branch circui!
<br />
<br /> b) 'lEe fee for brauch circut$ without
<br /> purchase 9f ~c:rvige 9[ fe~der fe~
<br /> First branch circuit
<br /> Each additional bra~ch circuit
<br />
<br />E. Miscellaneous (Service or Feeder Not Included)
<br /> Each pump or in/gafiC~ circle
<br /> Each sign or o011ine lighting
<br /> Signal ci~uit(s) ~ a li~l~it~d energy
<br />
<br />17, ]~ach addiEonal
<br /> OVer the allowabin in any of the
<br /> above, per In.*puction
<br />
<br />G, Minor installation Labels
<br /> Pack of 10 labels @ $5.00 each
<br /> (sold only Io eleclrical contractors)
<br />
<br />H. Other
<br /> ( A~ requgrad by ~uilding OffELal)
<br />
<br /> 50.00
<br />
<br />$100.00 __2
<br />$130,00 __2
<br />$300,00 __2
<br />$40.00 __2
<br />
<br />$35,00 2
<br />$40,00 2
<br />$80.00 __2
<br />
<br />$2,00
<br />
<br />$~5.00
<br /> $2,00
<br />
<br />$40.00 __2
<br />$40.00 __2
<br />
<br />$40.00 __2
<br />
<br />$35,00
<br />
<br />$50.00
<br />
<br />$. FEES
<br /> Al. Enter total of fees from Sec. #4
<br /> A2. Add 5% mmhargc (.05 x Al)
<br />
<br /> B, Enter 25% of linc A 1 for Plan Review
<br /> (Sec, 3), il req~irexl
<br /> C, InvestigationFee (ff required)
<br /> D, Rcinspecfion Fcc (525.00)
<br />
<br /> TOTAL AMOUNT DUE
<br /> ReceiptNo. : :
<br />
<br />
<br />
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