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FOR OFFICE*USE ONLY <br />Received <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am . 4:30pm <br />Coda .A-Pborm: 588,7~04 <br /> FAX: 585-79~8 <br /> <br /> SITE #: <br />ELECTRICAL PERMIT APPLICATION ' I Date: <br />Please complete all Sections, I through 5 <br /> , .... <br /> <br />P ERlv[I21S ARE NON.TRANSFER),BLI~ AND NON-REFUNDABLE A2qD <br />gXPlRE Il: WORK )'S NOT STAI~TIiD W1TIIIN lS0 DAYS OF ISSUA2qCE <br />OR IF WORK IS SUSPENDIgD FOR 1 SO DAYS. <br /> <br />211. FOR OWNER INh*FALLATION$ <br /> <br />Property Owner <br /> <br />Mailing Address <br /> <br />City/Siam/Tip <br /> <br />The inawfllatlon is being made on pfo~' I own which is no[ intended for sale, <br /> <br />O'0.mcr's Signature <br /> <br />3- PLAN REVIEW SEC'I'ION <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, pla~s, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 1119l <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />1000 sq. fl_ or less <br />Each additional 500 sq. <br /> or posen thereof <br />Limited Energy <br />Each ManuFd Home or Modular <br /> Dwelling 9erv~ce or Feeder <br /> <br />$85.00 4 <br /> <br />$~5.00 ~ <br />$20.00 1 <br /> <br />$40.00 -- 2 <br /> <br /> 201 amps to 4(~0 ;unps <br /> 401 amps to 600 amps <br /> 601 am~ps~to I000 amps <br /> <br /> 201 amps to <br /> 401 amps to 600 amps <br /> Over 600 anaps ct l(X)0 voltx <br /> <br />D. Branch CirCuitS <br /> <br /> a) The fee for branch cireuit~ <br /> <br /> Each branch circuit <br /> <br /> 9,50,00 <br />$60.00 <br />$100.00 <br />9130.00 <br />$300.00 <br />940.00 <br /> <br />$35.00 .... ~ <br />$4000 2 <br />$8000 ~ <br /> <br />$35.00 ....... <br /> $2.00 <br /> <br />$40.00 .... 2 <br />Sa000 ...... 2 <br /> <br />$4000 --. 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Enter tOtal of fees from Sec, #4 <br /> A2. Add 5% ~urcharge (.05 x Al) <br /> <br /> St~hio~al <br /> <br /> B, Enter 2~% of line A 1 for Plan Review <br /> (Sec, 3), if required <br /> C. InvestigationFee (if required) <br /> D, Relnspeglic~ Fee (525 <br /> <br /> TOTAL AMOUNT DUI:. <br /> <br /> Receipt No. <br /> <br />$ l Do~-,~° <br /> <br /> <br />