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FOR OFFICE USE 'ONLy MARION COU_NT'~BUILDING INSPECTION <br />Received by:, I 1~---' 220 High Street NE <br />Date: ~ I OiA/ Salem, ~gon 97301 <br /> <br /> ~¢-A-~e; 588-7~ <br /> F~: 588~7~8 SITE ~: <br /> ELECTRICAL PE HMIT APPLIGATION " Date: <br /> Please complete all Sections, 1 througq,,,~J <br /> <br />1. LOCATION OF IN,qTALLATION <br /> <br />,lob Add.ss t~t [ <br /> <br />Directlc~s <br /> <br />Cross St. <br /> <br />~;XF~RE IF WORK IS NOT STARTED VvTI'I I1N I80 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CON~fRACTOR INSTALLATION ONLY <br /> <br />2B. POR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mailbag Address <br /> <br />City/State/Zip <br /> <br />Phone <br /> <br />The installation is being made on property I own which is not intended for sale, <br /> <br />Owner's Sigmmm <br /> <br />3. PLAN RE¥1IgW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 53 and submit two (2) sets of plans and specifications with <br /> this application. <br /> <br />This optional plan review pregram does not suspend the <br />reqnired submission of lighting power calculations, plans, <br />and specificat/ons when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15.34 11/91 <br /> <br />PermitNo, <br /> <br /> Issued by: <br /> <br /> 4. Ih~EE SClClEDULE (Complete and enter total in A 1 below) <br /> <br /> Number of Inspections per permil allowed <br /> <br />A. <br /> Residential <br /> Unit <br /> Service Included: Items Cost (each) Sum <br /> <br /> 1000 sq, fL or less $35.00 <br /> Each additional S00 sq, iL <br /> or ponlon thcmof $15,00 <br />Limlir~d Enema <br />Each Manufd ~ome or Modular <br />Dwelling Se~ine or Feeder Sd0.00 -- <br /> <br />B. Services or Feeuers (Does not mlcude branch clrcults, see seclion D) <br /> Installation, Alterations or Relocaaon <br /> <br /> 2(RI amps or less $50.00 <br /> 201 amps to 4re amps __ $60,00 <br /> 401 amps to 600 amps $100.00 <br /> 60I amps to 1000 amps $130.00 <br /> Owr 1000 amps or volts $300.00 <br /> Reconnect only $40.00 <br /> <br /> C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less $35,00 <br /> 201 amps to 400 amps $40.00 <br /> 401 ammpss to 600 amps $80.00 <br /> Ovcr 600 amps or 10~X) volts <br /> <br />D, Branch Cireuit.q <br /> <br /> a)The fcc ~or branch circlg.',S with <br /> purchase 9~Jiervicc or feeder <br /> <br /> Each branch circuit <br /> <br /> b)The fee for branch circuta without, <br /> purch~$~.of service or fce0~ <br /> <br />Fks[ branch circuit <br />Each additional brach circuit $9,00 <br />E. Miscellaneous (Service or Feeder No~ included) <br />Each I~mp or irrigation circle $40.00 <br />Each sign or outline lighting $40.00 <br />Signal circuit(s) or a limiged eneggy <br />panel, alteration or extension $40.00 <br /> <br />F. ['-ach additinnal Inspection <br /> <br /> above, per Inspection -- $a$,00 <br /> <br />G, Minor Installation Labels <br /> Pack of I0 labels @ $5.00 ~ach $50.00 <br /> <br /> (As reql,;red by Building Official) <br /> <br />5. FEE~ <br /> Al, Enter total of fees from Sec. #4 <br /> AZ, Add S~o surcharge (~05 x A 1 ) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Sec. g), if v*quired <br /> C. Investigatlon Fee (ff mqulred) <br /> D. Rcinapscaon Fee ¢25.00) <br /> <br /> 'IK)TAL AMOUNT DUE <br /> <br /> Receipt No, <br /> <br /> <br />