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FOR OFFICE USE ONLY Received by;. Date: MARION COUNTY BUILDING INSPECTION 220 High Street NE Salem, Oregon 97301 Phone 588-5147 8:00 am - 4:30?m Code-A-Phone: 588-7904 FAX: 588-7948 SITE #: ELECTRICAL PERMIT APPLICATION P/ease complete all Sections, 1 through 5 I- LOCATION OFINSTALLATION Permit No, Date: Issued by: PI~RMYI'S ARE NON JII, L~4SFERABLE AND NON-REFUNDABLE A/~D EXPIRE IF WORK iS NOT $'I3.RTED WiTI I/~ 180 DAYS OF iSSUANCE OR tt~ WORK tS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLKflON ONLY Elect Seal Cc~tracmr Ma~Eag Address prapcay Owner [ Phone Contractor's Board Reg. No. Signature of Supervising ~lectrician Sx,pervi~of a Licen~ No, 2B, FOR OWNER INSTALLATIONS IJob No. Iphone Nc,. Mailing Address Phone Wc will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application, This optional plan review program does not suspend the required submission of lighting power calculations, plans, sad specifications when required by the Oregon Structural Specialty Code, Chapter 53. MC 15.34 11/91 4, FEE SCHEDULE (Complet* and enter Iotal in A 1 below) Number of Inspections per permit allowed A. Residential Per Unit Service Included: Itern~ Cost (each) Sum/ 10(K) ~ , R, or less $85.00 Each a~dltiona] 500 s~. ft. orpertlon thereof $15.00 Lima~d Eno $20.00 -- Each Manu~'~ome or Modular Dwelling Se~vim or Feeder $40,00 __ B. Services or Feeders (Doe~ not inlcude branch circuits, ace section D) amps or ~eO,O0 20t am~ to ~ amps ...... ~1 am~ [o 6~ ~ps ~ $100.00 __ 2 ~1 amps to 1~0 am~ ........ $130.00 ~er 1~0 ~pa or volts $800.00 Re~mae~ rely $40.00 2~ amps or ~sa $35,00 ~ 2 20[ ~ps to 400 ~p* $40,00 __ 401 ~xp~s to ~0 amps $80,00 __ 2 ~er 600 amps or 10~ volts Branch Cimults a) q~e f~ for branch dmMts ~ith Each brach c[mu~t $2.00 b) ~e f~ f~ bratleh ~fcats wi~out ~¢~a~e of ~e~ice or feed~ ~ Fi~[ branch ¢imult $35.00 Each ~dhonal bran~ cimuit ~ p~p ~ iffiga~on title $40.00 ~ 2 Each si~ or ou~¢ ~htMg $40.00 S~nal cimult(s) or a li~d enemy ~cl, alteration ~ ext~sion $40,00 __ 2 a~. per ~cfion $g5.00 Pack of 10 la~ls ~ $5.00 each (As reqdred by BaEEing Offic~0 5. FEES A I, Enter total of fees from Sec, #4 A2, Add 5% surcharge (.05 x Al) B, Enter ~% of line Al for Plan Review (S<. 3), if mqalr~ C, ~v~tigationFee~ 0f required) D. Remspectim Fee ~TAL A~OU~ DUE R~e~ No.