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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 />Please complete all Sections, 1 through <br /> <br /> 1. LOCATION OFINSTALLATION <br /> <br /> JchAddrc , ,10OO8 <br /> <br />PERM1TS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXP~.E IF WORK IS NOT STARTED W1TaZN lS0 DAYS OF ISSUANC~ <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Szsna,,te of SuPervz,mg Elccmcaa~~"~...~ <br /> <br />2B. FOR OWNER INffI~ALLATION5 <br />Property Owner <br />Marlin$ Address Phone <br />C~ty~tate/Zip <br /> <br />Thc installation is being made on property I own which is net intended for sale, <br /> <br />Owners Signature <br /> <br />PLAN REVIEW SECTION <br /> <br /> Wc will provide plan review service it' 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 docs not suspend the <br />mqukod submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Co~-A-Phone: 588,7904 <br /> FAX: 588-7948 <br /> <br />MC 15-34 11/91 <br /> <br />4, ~E 8C~U~E (C~¢tc ~d ~ter to~l ~ A 1 bclow) <br /> <br />A, <br /> Resldeatlal <br /> Unit <br /> $e~l~ Include: It~ls Cost (e~h) Sum <br /> <br /> 10~ sq. f~ ~ less $85.00 ~ 4 <br /> Each a~fi~l 5~ sq. <br /> ~ ~m ~c=of $15.00 <br /> L~m~ne~y $20.00 1 <br /> g~h M~ufd Home or M~ular <br /> Dw~g Se~ ~ Feed~ $40.00 <br /> <br /> Ins~lla~on, Alterations or Rd~aflon ~ <br /> <br /> ~I arum to 1~0 a&~ fi- $130.00 <br /> ~et I~ ~pe or v~ts ~/' $300.00 2 <br /> Re~nne~ ~ly ~ $40.00 2 <br /> <br /> Installation, AEeraUon, 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 /> see "B" above <br /> <br />D. Branch Cirettffs <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for btai~ch citcthts with <br /> e ~e of feeder fee <br /> <br /> 'Each branch circuit <br /> <br /> b) The fee for branch drcuts without <br /> purchase of service or fe~der <br /> <br /> First branch <br /> Bach additional branch circuit <br /> <br />E, Miscellaneous (Service or Feeder Not Included) <br /> BIw21 pump ot irdgalion Circle <br /> ]~ch sign or Ollthnc lighting <br /> Signal circui[(s) 0r a limited energy <br /> panel, alteration or extension <br /> <br />F. Each additional Inspeetlon <br /> over the allowable in any of the <br /> above, per Impeefion <br /> <br />G. Minor lnstallaUon Labels <br /> Pack of 10 labels @ $5~00 each <br /> ($oM oMy to dectrlcal contractom) <br /> <br />H. Other <br /> ( As required by Building Official) <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 --2 <br />$40.00 <br /> <br />$40.00 __2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> Al, Enter total of fees from Sec, #4 <br /> A2, Add $% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of IJ~e A1 for Plan Review <br /> (Sec. 3), if required <br /> C, Investigation ~ee Of requited) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No, . ....... <br /> <br /> <br />