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FOR OFFICE USE ONLY <br />ReceWed by: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Stree.t, NE <br /> Salem, Oregon 97301 <br /> <br /> phone 5SS-$147 $:00 am - 4:~07m yOG.F~/ <br /> Code-A:ghone: ~88~7~4 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATI°N OF IN~TALLATION <br /> <br />p~ ~E NON-~S~RABLE ~D NON-RE~AB~ ~ <br />~E ~ WO~ IS NOT STARED ~ 180 DAYS OF ISSU~CE <br />OR ~ WO~ IS SUS~ED FOR 180 DAYS, <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Prop~ro] Owner <br /> <br />Mailing Address Phone <br />City/State/Zip <br /> <br />%e inst,allafion is ~elng made on progeny I own which is $ac¢ intended for sale. <br />le.,ase~ or fegnL <br /> <br />We will provide plau review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this applioation. <br /> <br /> This optional plan review p~ogxam does not suspend the <br /> required submission of lighting power calculations, plans, <br /> and specifications when reqeired by the Oregon Structural <br /> Speci~ty Code, Chapter 53. <br /> <br />MC 15-34 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit NO. <br /> <br />4, FEE SCHEDULE (Complete a~d enter total in A l b~low) <br /> <br /> Number of Inspections pet' permit allowed <br /> <br />A. <br /> Residential <br /> ~r <br /> ~nit <br /> S~lee InduCed: It~s C~ (each) S~t <br /> <br /> 1;~ sq, fL or less $85.00 ~, <br /> Ea~ ad~fio~l 5~ aq. <br /> er ~ tha~of $ ] 5.00 <br /> ~it~ Enemy ......... $20.00 <br /> Each Manufd H~e or M~uhr <br /> Dwc~ng Se~ or F~d~ $40.00 ....... <br /> <br />B. Ser~ or Feeders ~ n~ ~lcudc b~nch dmuits, ~e ~e¢~ D) <br /> <br />Installation, Alterations or Relocation -'~ <br /> 200 amps or less , <br /> ?lit amps to 4~ ~mp~ .. <br /> ~I am~ ~ ~ amps <br /> ~1 am~ to I~ amp~ <br /> <br />2~ ~ps or <br /> <br />b) %e ~ for ~ch 6mats ~ <br />~reb~ge of se~ee or f~,e,der fee <br /> <br /> Fire branch <br /> <br /> $$0.0o <br /> $60.00 <br />$100.00 <br />$130.00 ~2 <br />$300,OO <br /> $40,00 __ 2 <br /> <br />$35.00 <br />$40,00 <br />$~0.00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40,00 <br />$40,00 <br /> <br />$40,OO a <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> FEES <br /> <br />Al. Enter total of fees from Sca. #4 , <br />A2. Add 5% surcharge 605 x Al) <br /> <br /> Subtotal <br /> <br />B, EnterS-5% of lineAl forPlanReviow <br /> (Sec, 3), if mquired <br />C, InveslJgationFee (if t~qinred) <br />D. Reinspecfion Pee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt N'c, ..... <br /> <br /> <br />