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FOR OFFICE USE ONLY <br />ReCeived by: <br />Date: <br /> <br />MARION COUNTY BUILD]lNG INSPECT]ION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 5sg-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7945 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ali Sections, I through 5 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Pon'nit No. <br /> <br />PER3/iITS ARE NON-TRANSFERABLE AND NON.REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED wrll-llN 1 S0 DAYS OF ISSUANCE <br />OR IF WORK I$ SUSpISNT)ED FOR 180 DAYS, <br /> <br />F-~ARK I N I:]-_-I_E[C'I"F.: :[ C r I NC. <br />:;;it012,5:iO S M(]L_ALL_A AVENUE <br />OREGON CI'l-Y:, OR 97045 <br />2,46.-- 130 ]. <br /> <br />2B. FOR OWNER INRTALLATIONS <br />Property Owner <br />Mailing Address Phone <br />City~t ate/Z]p <br /> <br />Ow'her's Signature ,, <br /> <br />3. PLAN REVIEW SE(yrION <br /> <br />We will provide plan review 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 tho <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4, FEE SCHEDULE (Complex- sod enter mm[ in A 1 below) <br /> Numl~r of Inspections per pumU allowed --] <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> / <br /> Service Included: Itt~rns Cost (each) Sum <br /> <br /> $85.00 , , 4 <br /> 10~0 sq. fl_ or l~ss <br /> l~ach additional 500 sq, ft, <br /> or pardon thereof $15.00 <br /> Limited Ea~rgy $~0,00 __ 1 <br /> Each Manufd Home or Modula~ <br /> Dwelling Service or Feeder $40,00 __ 2 <br /> <br /> [nstallathm, AIt~atinns or Relocation <br /> 200 amps or less $50.00 __ 2 <br /> 201 amps to 400 amps $60,00 __ 2 <br /> 401 mnps to 600 amps $100.00 __ 2 <br /> 601 amipslto 1000 amps $1~0.00 __ 2 <br /> Over 1000 amps or volts $300.00 ,. 2 <br /> R¢conne/~ caly $40.00 __ 2 <br /> <br /> C. Temporary Servlce. s/l*eedgcs <br /> <br /> 200 amps or less $35,00 2 <br /> 201 amps to 400 amps $40,00 __ 2 <br /> 401 araps to 600 amps $$0,00 __ 2 <br /> Over 600 amps or I000 volts <br /> <br /> D. Branch Circuits <br /> New, Air.arian, or F. xtensinn Per Panel <br /> <br /> a) The f~ for branch 6fcults w~h <br /> <br /> Each branch tin:ail $2.00 <br /> <br /> First branch clrct~t $3.5,00 <br /> F~h add,tie.al branch circuit $2.00 <br /> <br /> Each pump or irdgatirm cJtcle $40,00 2 <br /> Each sign or eating lighting $40,00 2 <br /> S~gnal c{rcuit(s) or a I/mired energy <br /> panel, alteradon or extension $40.00 __ 2 <br /> <br /> E ])]ach aclditional Inspection <br /> over the allowable in any of the <br /> above, per Inspection $35,00 <br /> <br /> Pack of I0 inbols @ $5.00 each $50.00 <br /> (zold only to electrlca/ contractors) <br /> <br /> ( A.* required by Building Official) <br /> <br />5. FEES <br /> <br /> Al, t~nter total of fees from Sec. 644 <br /> A2. Add 5% sumharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Emer Z5% of line A 1 for Plan Review <br /> (Sec. 3), if required <br /> C- Investigation Fee (if requital) <br /> D. R~inspectioa Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br /> <br />