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FOR.' OFFICE USE ONLY MARION COUNTYBUILDING INSPECTION <br />R.~..~uved b~,. I 220 High StreetNE _ _ <br /> <br /> ELECTRICAL PERMIT APPLICATION I o- Date: ,~ <br /> Please complete all Sections, 1 through5 ~ MARION COU~13 _ <br /> <br /> 1. ~TION OFIN~AL~TION <br /> <br />PERM1TS ARE NON-TRANSFERABLE AND NON-REFUNDABLE .fuND <br />F~XPI~.E IF WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR J~ WORK IS SUSPE~IDED FOR I $0 DAYS, <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />C°ntracto's II0ard Res: N°' ~ .~ f <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Pmper~y Owner <br /> <br />Mailing Address Phone- <br /> <br />CBy/S[a~4Z/p <br /> <br />The imtallafion is being made on pfolx~y I own which is nm intended for sale. <br /> <br />Owneffs Signatu~ ................ <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 requked by ~he Oregon Structaml <br />Specialty Code. Chapter 53. <br /> <br />MC15-34 11191 <br /> <br />PermltNo. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 bolow) <br /> <br />A. <br /> Residential <br /> Unl~ <br /> Service Included: hems Cmt (each) Sm <br /> <br /> 1000sqs, fl. ct less --- $85.00 ....... 4 <br /> g'aeh a~ld/t/onal ~00 sq. ft. <br /> <br />Each Mana£~ Homy or Meduhr <br /> <br /> 50.00 <br /> 200 ~ml~ or l~zs $ $60.00 __ <br /> 201 ~mp~ to 400 amps __ <br /> 401 ~m~ ~o 600 ~mpe $~00.00 __ <br /> 601 am~pslto 1000 amp~ $~ SO.er 2 <br /> Over 1000 amps or rolls $800.00 __ 2 <br /> R~mne~ only $40.00 __ <br /> <br /> 200 trope or less $.35.00 . <br /> 201 ~mps m 400 amps $40.00 __ <br /> 401 amps w 600 amps $80.00 __ <br /> Ove[.,6,0,O, ampe or 1000 volts <br /> s~ B above <br /> <br /> a) The fee for branch c./mollz ~ <br /> <br /> Each br~nch c//cuit $~,eo <br /> <br /> b) The fee for branch elf*uts wi~out <br /> rJu rebate of.qe~ice ov feeder..~,.~ <br /> <br /> Fir*t branch ¢ircuh $~S.00 <br /> Each additional branch cixcult $~,1~) ..... <br /> <br /> E. Miscellaneous (Service Or Feeder Not Included) <br /> Each pump or ~rdgati~l c~rcl¢ $40,00 <br /> Each sign or outl/nc lighting ___ $40,00 __ 2 <br /> <br /> panel, almratlon or extension $40.00 __ 2 <br /> <br /> c~vcr the allowable in any of th~ <br /> above, per ~nspu¢.ion SBS .00 <br /> <br /> Pack of l0 lal;~$ @ $~.00 each $50~00 <br /> (~old only to electrical cordractor$) <br /> <br /> ( As rtqu~red b~ Buitding Offic;~O <br /> <br /> S. FEES <br /> Al, Ent~r total of fec$ from S¢c. #4 $ ~ <br /> A2, Add 5% surchaeg~ (.05 x Al) <br /> $ <br /> <br /> Subto~l $ <br /> <br /> B. Enmr ~% of ~e A 1 for H~ ~vinw <br /> (S~- ~). if ~q~ $ <br /> <br /> D. ge~s~6~ F~ ($~) <br /> <br /> ~TAL ~O~ DUE <br /> <br />.... <br /> <br /> <br />