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FO.R OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 S:00 am - 4;30pm <br /> Code-A-Phone: 585-7904 <br /> FAX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> 1. LOCATION OF INSTAi,LATION <br />Job Address ~-'~ Z-'~ <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />I Cross St. / <br /> <br />PERMIq's AR E NON-IRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT $'iARTED WITI lIN 1 $0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRA(YrOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER INfffALLATION$ <br /> <br />Property Ow:let <br />Mailing Acklress Phone <br />City/State/Zip <br /> <br />Thc instalIat[otl is being made on property I own which is not intended for sale, <br /> <br />~ ¢--- i ) ~ .0. ~plete Section <br /> cations with <br /> <br />;pend thc <br />Ons, plans, <br />I Structural <br /> <br />4. FEE SCHEDULE (Complele and enler total in A 1 below) <br /> <br /> Number of In~poetiuns per permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> Set,lice Included: Item~ Cost (each) Sum <br /> <br /> 10(X) sq. ft, or less $85.00 <br /> 4 <br /> Each ac*Mifional 5(X) sq. ft. <br /> Or ponlon thereof $ t 5.00 <br /> Lirnilud Energy $20.00 -- I <br /> <br /> Dwclllng Service o~ Feeder $40,00 __ 2 <br /> <br />B. Services nr Feeders (Does no inlcudc branch c to/its, see section D) <br /> Installation, Alterations or Relocation <br /> 50.00 <br /> 200 amps or less $ $60.00 <br /> 201 amps to 400 amp~ <br /> 401 amps to 6(X) ai~lps $100,00 __ 2 <br /> 601 amps ~o 1000 amps $180.00 __ <br /> $300.00 <br /> Reeom~eet only $40.00 2 <br /> <br />C. Temporary Services/I eeders <br />Installation, Alteration, or Relocathin <br />200 amps or less $35.00 -- 2 <br />201 a~lps IO 400 amps $40.00 -- 2 <br />401 amps tO 600 amps $80.00 <br /> <br />D, Branch Circuits <br />a) Thc fee for branch CirCuits with <br />Each branch circuit $2.00 <br /> <br /> First branch circuit [ $35.00 <br /> Each eddltional branch circuit $2,00 <br /> <br />E. Miscellaneous (Service or Feeder Not lllchided) <br />Each pu,~p or irrlga~ion circle $40.00 <br />Each sign or outline lighting $40.00 -- 2 <br />S/gnal circuit(~) or a Emit~d ~ncrgy <br /> <br /> alyove, per Inspect[on $35.00 ..... <br /> Pack of I0 labels @ $5.00 each $50.00 <br /> <br /> ( A,~ reqt~ir*d by Building Official) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. 1t4 <br /> A2, Add 5% surchapge (.05 x A I) <br /> <br /> (Sec, 3). if required <br /> C, Investigation Fee (ff required) <br /> D, Reinspecticm Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ ~ <br /> <br />MC 15-34 11/91 Receipt No. <br /> <br /> <br />