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~OR. OFFICE USE ONLy <br />Recei4ed by: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Sweet NE <br /> Salem, Oregon 97301 <br /> <br /> Phonc 588-5147 8:00 ~n - 4:30pm <br /> Code-A-Phone: 5884904 <br /> FAX: 588-7948 SITE #: <br /> <br /> Dato: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />Description <br /> <br />PERMrI'S ARE NON-TRANSFERABLE AND NON.REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WlTIilN 180 DAYS OF ISSUA2~CE <br />OR IF WORK 18 8 USPF~DED FOR I $0 DAYS, <br /> <br />Permit No. <br /> <br /> 201 aml~ to 400 ttmps <br /> 401 aml~ to 6~ amps <br /> 601 ~mq~lto I000 amp~ <br /> O~r 1000 amps or volta <br /> <br />C. Temporary Services/Feeders <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or I000 volts <br /> <br />D. Branch Circuits <br /> <br /> a) The fcc for bnmch drenits w~th <br /> <br /> Each branch c~mult <br /> <br /> b) The fee for bruno drcuts ~vJJhorg <br /> purchase of sea/ce or feeder fee <br /> <br /> 80.00 2 <br /> ~6o.oo <br /> __2 <br />$100.00 __ 2 <br />$1 SO.00 __ 2 <br />$800.00 __ 2 <br />$40.00 ,, 2 <br /> <br />$35,00 <br />$40,00 <br />$80,00 <br /> <br />$2,00 <br /> <br />~II. FOR OWNIgR INSTALLATIONS <br /> <br />~ropurty Owner <br />Maillog Address Phone <br />City/State/Zip <br /> <br />~l~e installation is beiag made on property I own which is not ~tmldcd for sal~. <br /> <br />Ownc?s Signature <br /> <br />PLAN REVIEW SECTION <br /> <br />We will provide plan rev/ew 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 />~eqaired submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br /> Fi~t branch circuit $38.00 <br /> Each additional branc.;h elf*nh __ $2,00 <br /> <br />E, Miscellaneous (Service or Feeder Not Included) <br />Each pump or in~gafic~ circle $40,00 2 <br />Each sign or outline UghiJng $40.00 l~__ 2 <br />Signal circuit(s) or a ]Lmit~d energy <br />panel, ah~ratlon or cxt~mslon $40.00 -- 2 <br /> <br />F. Each addRlonal Insp~tlon <br />over thc allowable in any of the <br />above, p*r I~spectlon $88.00 <br /> <br />G. Minor Ins~Eation Labels <br />Pack of 10 lalzeAs @ SS.00 each $50.00 <br />(sold only lo electrical contractors) <br /> <br />H. Other <br /> (As required by Building Official) <br /> <br />5. FEES <br />Al. Eatcr total of fccs from $¢c. #4 $~-ff~ <br /> AZ. Add 5% surcharge (.05 x A1) $ ,&~ ~ O <br /> <br /> Subtotal $ <br /> <br /> B. Enter ~5%oflineA1 for Mar~Review <br /> (Sec. S), if required $ <br /> C, l~vc~fignfionFee (ff requircd) $ <br /> D, Re~nspecfion Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> R~ceipt Nc,. __ <br /> <br /> Issued by: <br /> <br />4. FEE SCHEDULE (Complete al*d enter total in A1 below) <br /> Number of Inspections per permit allowed ~ <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: ~tcms Cc~t (each) Sum <br /> <br /> t0~0 sq. ft. or less $85,00 4 <br /> Each a~]ditional 5130 gq, ft. <br /> or portion thereof $15,00 <br /> LJmlted Energy $20.00 __ l <br /> Each M~nu£d Home or Modular <br /> Dwelling Service or Feeder $40.00 -- ~ <br /> <br />B, ServJge~ or Eeed~r~ (Docs not inlcudc branch clrcu~ts, sec section D) <br /> Installation, Alterations or Relocation <br /> <br /> <br />