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[FOU OFFICE US . ONLY <br />I 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 8:00 am - 4:30pm <br /> Code.A.Phone: 588-7904 <br /> FAX: 58S.7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION [ Date: <br />Please complete all Sections, I through 5I Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />PF~ITS ARE NON-~NS~BLE ~ NON-I~NDAB~ ~D <br />EX~E IF WORK IS NOT STARTED ~'I~ 180 DAYS OF ISSU~CE <br />OR IF WORK IS SUSPENDED POR 180 DAYS. <br /> <br />2A, CO,RAZOR IN~ALLATION ONLY <br /> <br />Mailing Address <br /> <br />property Owner <br />Contractor's License No. <br /> <br />Signam~ o~ SUl~islng El¢¢tfioia~ ~ <br /> <br />Ilob No. <br /> <br />l'hon¢ No, <br /> <br />2B, FOR OWNER INSTALLATIONS <br />Pmpsay Owner <br />Mail/nE Address Phone <br /> <br />Cay /Sm~ef/Ap <br /> <br />The installa~on is beh~g mad¢ on property i own which is are illtx:nded for sale, <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan review service if yOu complete Section <br />5B and submit two (2) gets 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, plans, <br />and specifications when required by the Oregon Structural <br />Speciahy Cede, Chapter 53. <br /> <br />MC ]5-34 ]1/91 <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al b~low) <br /> <br />A, ~ees im ~iceen }ina~ i uP~[.dU: n i t Number °f lnspecti°ns i~r permB all°wed <br /> Ilems r_.ost (each) Sum-- <br /> <br />1000 sq. ft. or less $85.00 __ 4 <br />Each additional 500 scl. ft, <br />or por ti. cn~ themof $15.00 <br />Limitcd Energy $20,00 1 <br />Each Manufd I Ivmu or M~dalar <br />Dw~lllng Se~ic:e- or l~eeder $40.00 __ 2 <br /> <br /> lnsiallatlon, ARerathins or Relocation <br /> 50.00 2 <br /> 200 amps or less $ ~60.00 ! ' <br /> 201 amps to 400 amps __ 2 <br /> 401 amps to 600 amps $100.00 __ 2 <br /> 601 amps to 1000 amps $130,00 2 <br /> Over I000 ~nps or vol~s $300,00 2 <br /> Reconne. c[ only $40,00 __ 2 <br /> <br />C. Temporary Servl¢es/l[*eeders <br /> <br /> 200 amps or less $85.00 __ 2 <br /> 201 ~mps to 400 amps $40.00 .... ~ <br /> 401 ~trnps to 600 amps $80,00 -- 2 <br /> Over 600 ~nps or lO00 volts <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) Thc fee for b~anch circuits with <br /> purchase of servic~ or fe~er fee <br /> <br /> Each brach ckcoit $2,00 <br /> b) The fee for branch circuts without <br /> <br /> ( As required by Building Officia0 <br /> <br />5. FEES <br /> Al. Enmr total of fees from Sec. #4 <br /> Ae. Add 5% surcharge (.05 x A 1 ) <br /> <br /> Subtotal <br /> <br /> E. enter 25% of llne Al for Plan Review <br /> (Sec. 3), if required <br /> C. InvestigatlonFee (if required) <br /> D. Reinspeclion Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br /> <br />