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FOR OFFICE USE ONLY <br />Received by: <br />Dat~: ' <br /> <br />I MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> phone 5SS-5147 8:II0 am - 4:30pm <br /> Code-A-Phone: 558-7904 <br /> FAX: 5SS-794S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, 1 through 5 <br /> <br />Date; <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />1, LOCATION OFIN$TALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />gXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPI~DED FOIl 1 $0 DAYS, <br /> <br />2A. CO~rRACTOR INSTALLATION ONLY <br /> <br />211, FOR OWNER INSTALLATIONS <br />Property Owner <br /> <br />Mailing Address '~hone <br /> <br />City/Star.Zip <br /> <br />lease, or rent. <br /> <br />Owncgs Signature ..... <br /> <br /> PLAN REVIEW SECTION <br /> <br />We will provide plan review 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 dragon Structural <br />Speclal~y Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />4. FEE SCHEDULE (Complete and enter total/n A1 below) <br /> Number of Inspections per permit allowed --I <br />A. <br /> Reslaential <br /> Per <br /> Unit <br /> 1 <br />Service Included: Items Cost (each) Suml <br />1000 ssa. ft. or les~ $85.00 -- 4 <br />Each a~lditional 500 aq. ft. <br />or portica thereof . , $15.00 <br /> $~0,00 <br />vL, imitod Ene __ 1 <br />Each Manu~'~[Iom¢ or Modulae <br /> Dwelling Se~Aa~ or Feeder $40,00 ....... 2 <br /> <br />B, Services or Feeders (Does not mlcode branch ci rctlits~ s6¢ sccdon D) <br /> <br /> Inatallatlon~ AIt~ations or Relocation ~ <br /> 200 amps ot less <br /> <br /> 401 amp~ to ~ amps <br /> 601 aml~ to 1000 amps <br /> O~er 1000 amps or volts <br /> Reca3nn~ct only <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration~ or Relocation <br /> 2IX) amps or less <br /> 201 ~mps to 400 amps <br /> 401 srnps to 600 amps <br /> eve,r, 600 amps or 1000 voh~ <br /> see B" above <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) 'l~le fcc £or branch c, lre~its with <br /> p~chase of service 9r.;[eeder fee <br /> <br /> Each branch <br /> <br /> b) 'Die f~ for branch clrcuts ~ <br /> parcham of ~erviee 9L~ed~r <br /> <br /> Fh~l branch circuit <br /> Each additional btanc, h circuit <br /> <br />E, Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irrigaaon circle <br /> Each alg~ or outline Iighfing <br /> S/gnal cireuli(S) of a limited energy <br /> pan¢I, alteration or extension <br /> <br />F. Each adaltinnal Inspection <br /> over the a//owablc in any of the <br /> above, per Xnspeetion <br /> <br />(3, Minor Installation Labels <br /> Pack of 10 labels @ $~,00 each <br /> (~old only to ~l~ctrleal contractors) <br /> <br />H. Other <br /> (As required by Buildigg Offi¢ia <br /> <br /> 50 O0 <br /> <br />$100,00 <br />$130,00 <br />$300.00 <br />$40,00 <br /> <br />$35.00 <br />$40.00 <br />$80.00 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />SSO.OO <br /> <br /> FEES <br />A 1. Enter tokai of fees from Sec, #4 <br />Ae. Add 5% sareharge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B, Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required <br />C, InvcxtigadoaFee (if rcqu{red) <br />D, Reinepection Fcc ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. , <br /> <br />$ <br />$ <br /> <br /> <br />