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FOR OFFICE USE ONLY <br />Received by:. <br />Date: Z .... <br /> <br /> Salem, Oregon 97301 <br /> <br />Phor~e 588-5147 8:00 am - 4:30pm <br />Cod~-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> SITE #: [{~l~ 0 ~ ff~t No. <br /> Date: <br /> I~sued b~UILDING INSPECTION <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />pERS/IITS ARE NON-TRANSFeRABLE ~ NON-I.~EUNDABLE AND <br />EX,RE IF WORK IS NOT STARTED WITHIN 150 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COIqTRACrOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />P~operl. y Owner <br /> <br />Ma~ng Address TPbone <br /> <br />City/State[Zip <br /> <br />The installation is being made on pmparty I own wl'dch is not intended for sale, <br /> <br />Owners Signature .......... <br /> <br />3- Pt,AN RE¥1EW SECTION <br /> <br />We will proyide plan review service if you complete Section <br />5g 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 />MC 15-34 11/91 <br /> <br />4. FEE $CllEDULE (Complete and ~nter total in A 1 below) <br /> Number of I~spcctlons per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service- Included: tams Cost (each) Sum <br /> 1000 sq. fi. or le~s $85.00 4 <br /> Each additional 500 sq. fL <br /> or potion thereof $15.00 <br /> Limited Energy $20,00 1 <br /> Each Manul'd Home or Modular <br /> Dwelling Servi~ or Feeder $40.00 <br /> <br /> In~tllatlon, Alterations or Rdoeatlon <br /> 200 amps or less $~0,00 __ 2 <br /> 201 amps to 400 amps $60.00 __ <br /> 401 amps to 600 amps $~00.00 <br /> 601 amp~ to 1000 amps __ $130.00 , ,, <br /> Over 1000 amps or volts __ SSO0.O0 <br /> Reconnect only $40.00 <br /> <br /> C, Temporary Services/Feeders <br /> Installation, Alteration, or Relocatlon <br /> 200 amps or less $35.00 <br /> 201 amps to 400 amps $40.00 <br /> 401 amps to 600 ttmps $80.00 <br /> Over 600 amps or 1000 volts <br /> <br /> D, Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) ~1~ fe~ for branch c~rcdits with <br /> <br /> Each branch circuit $2,00 <br /> <br /> b) Thc fee for branch cimuts widiout <br /> gAl~a~e of ~ervicc or feeder fcc <br /> First branch circtli[ / $S5.00 <br /> Each additional branch circuit ~ $2,00 <br /> <br /> E, Miscellanc~ms (Service or Feeder Not Included) <br /> Each pu~np or irrigation circle $40.00 __ 2 <br /> Each sign or oodine llghling $40.00 __ 2 <br /> Signal circuit(s) or a lltnitod c~l¢~y <br /> panel, alteration or extension $40,00 <br /> <br /> F. Each additional Inspection <br /> over fl~c allowable in any of die <br /> abovc, per Inspection $35,00 <br /> <br /> G, Minor Installation Labels <br /> Pack of 10 lal~ls (a) $5,00 each $50.00 <br /> (sold only to electrical contractors) <br /> <br /> (As required by B uildln8 Official) <br /> <br />$. FEES <br /> <br /> Al. Enter total of fees from Sec, t~4 ' <br /> A2, Add 5% sumharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of lineAl forPlan R~vicw <br /> (Sec. 3), if required <br /> C, Invest~ation~ee (if required) <br /> D. Reinspecticn~ Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />