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FOR. OFFICE USE ONLY
<br />Received by:. _ _
<br />Date,,; _ _
<br />
<br />ELECTRICAL PERMIT APPLICATION
<br />Please complete ail Sections, I through 5
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />
<br /> 220 High Streel~ NE
<br /> Salem, Oregon 97301
<br />
<br /> Phone 588-5147 8:00 ~n - 4:30pm
<br /> Code. A-Phone: 588.7904
<br /> FAX: 588-7948
<br />
<br />SITE #:
<br />
<br />Date:
<br />
<br />Issued by:
<br />
<br />PermitNo.
<br />
<br />1. LOCATION OF INSTALLATION
<br />
<br /> '
<br />
<br /> ,edp"on
<br />
<br />P FAr~M1TS ARE NON-TRANSFERABLE J~rD NON-RE~JNDABLE AND
<br />EXPIRE IF WORK IS NOT STARTED W1TIllN lS0 DAYS OF ISSUANCE
<br />OR IF WORK IS SUSPENDED FOR 180 DAYS.
<br />
<br />CONTRACTOR IN$~rALLATION ONIN
<br />
<br /> F::'ChF?.K ! N EZI,,.,E?,(',Z:'TFi: I C, I NC:.
<br />
<br /> OIq:E930N CZ('l"Y~ (31:R 97045
<br /> ;24-6,'"" 130 ~
<br />
<br />~)ll, FOR OWNER INSTALLATIONS
<br />
<br />Property Ow.er
<br />
<br />Address ] Phone
<br />
<br />City/State/Zip
<br />
<br />3- PLAN REVIEW SECTION
<br />
<br /> We will provide plan review sendce 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 />required submission of lighting power calculations, plans,
<br />and specifications when required by the Oregon Structural
<br />Specialty Code, Chapter 53.
<br />
<br />MC15-34 ]I/91
<br />
<br />4. FEE SCHEDULE (Complete and enter total in A 1
<br /> Number of Inspections per permit allowed '1
<br />
<br />A.
<br /> Residential
<br /> Per
<br /> Unit
<br /> /
<br /> Service Included.' Items Cos! (each) Suml
<br />
<br /> 1000s . fL or less $85.00 __
<br /> Each a~difional 500 aq, R,
<br /> or pot tic~ themof $15.00
<br /> Limited4r,-,,"E~e / $20,00 __ 1
<br /> Each Man~[lome or Modal. ar / $40,00 2
<br /> Dwelling Sc~ce or Feeder
<br />
<br />B. $ervlee~ or Feeders (Does not inleude brat~ch oirmlils, se~ section D)
<br /> Installation, AIt~'aaon~ or Relocation
<br />
<br /> 200 amp~ or less $50,00 __ 2
<br /> 20] amps to 400 amps $60,00 __ 2
<br /> 401 ampa to 600 amps $100,00 __ 2
<br /> 601 ~mEa_ .t° 1000 amps $130,00 __
<br /> Owr 1LVJO amps or volts $300.00 -- 2
<br /> Rccormcet o~ly $40.00 __ 2
<br />
<br />(2. T{mporary ServlcesJPe~ders
<br />
<br /> 200 amps or le~s $~5.00
<br /> 201 amps to 400 amps $40.00 __ 2
<br /> 401 amps ~o 600 amps $80,00 __ 2
<br /> Over 600 ~Lmpa or I000 voI[~
<br />
<br />D, Branch Circuits
<br />
<br /> a) The fc~ for branch cimuits with
<br />
<br /> ~ brknch cixcult
<br />
<br /> b) The fe~ for br~nch cimuts withq, gt
<br />
<br /> Fi~t branch circuit $35.00
<br /> Each additional branch cimu~t $2,00
<br />E. Misc~llaneou$ (Service or Feeder Not Included)
<br /> .T~I ch pump or irfigatioll c,,~C,] e $40.00 2
<br /> Each sign or o~tllne li, ghti~g __ $40,00 --. 2
<br /> Sig~tal ciz~it(s) or a Iirnlad co¢~gy
<br /> l~lle], allcraL{on or exteilslon $40,00 __
<br />
<br /> above, per In~puedon $35.00
<br />
<br />C, Minor Installation La~el$
<br />Pack of 10 labci~ @ $5.00 each $50.00
<br />(sold only ~o d~ctr&al contrectorv)
<br />
<br />H. Other
<br /> ( ~ mquired by Bu~ldb*g
<br />
<br />5. FEES
<br /> Al. Enter total of fees from Sec, #4
<br /> A2. Add 5% surcharge (.05 X Al)
<br />
<br /> Subtotal
<br />
<br /> E, Enter25% ot'Jin~Al for PlanRevlew
<br /> (S~, 3), if required
<br /> C- Investigation l~ec (if required)
<br /> D, Reinspucfic~ Fee ($25.00)
<br />
<br /> TOTAL AMOUNT DUE
<br />
<br /> Receipt No,
<br />
<br />
<br />
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