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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT,APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> ~ '~'~honc 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588,,7904 <br /> FAX: 588-794s SITE #: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OF INSTALLNI'ION <br /> <br /> I <br /> <br />PF~I~ ARE NON-~S~RA~LE A~ NON-~NDAB~ ~ <br />E~E ~ WORK IS NOT STAR~ED ~ 180 DAYS OF ~5UA~C~ <br />OR l g WORK IS SUS~DED FOR 180 DAY~. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Elect tlcal Crmtractor <br /> Phone <br /> <br />Mailing Addruas <br /> <br />Ptolemy Owner ] l'hon¢ <br /> <br />Contractor's Board Reg, No, <br /> <br />Sigoatu~ of Supervising Elect rician <br /> <br />Supervbor's Liceams¢ No, <br /> <br />2II. FOR OWNER INSTALLATIONS <br /> <br />llob No, <br /> <br />IPhone No, <br /> <br />The inst~la~ is ~ing ma~ on p~y I own w~ <br />Owner's SJgnatum~ . <br /> <br /> We will proyide pl~ review so.ice if you complete S~fion <br /> 5B and submit two (2) ~ts of plato aed sp~ificafions wi~ <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 Cede, Chapter 53. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> SCrvlcelnc Ude¢: ResidentlallPer Uni'Number of Inspections,,Per permit allowed <br />A, <br /> It.S Co~t (each) Sum-- <br /> <br /> $85.00 ~ 4 <br /> 10~ sq- ~ ~ less <br /> Ea~ ad~ti~a} 5~ sq- ff. <br /> ~ ~o~ thereof $15,00 <br /> ~i~ Enemy .... $20.00 -- 1 <br /> Each Mana~d Home or M~uhr <br /> Dw~ Se~m ~ Feeder ~ $40.00 <br /> <br />B, SerH~s or Feeders (Docs not inlcude branch circtdts, ~ee sec~io~ <br /> Ins~laOon, Air,arians or Reliction <br /> <br /> ~1 am~ to 4~ amps $60.00 <br /> <br /> ~1 am~ m 1~ amp~ $1~0,00 <br /> ~r 1000 mpa or volta ~ $~00,00 __ 2 <br /> ~m~eet ~ly $40.00 __ 2 <br /> <br />C. Tem~rary Servlce~'~d~s <br /> <br /> 2~ ~p~ orless $85.00 __ 2 <br /> 40.00 <br /> 201 ~P~mp~ to 400 am~ $~80.00 __ 2 <br /> 401~ zto~0am~ __ 2 <br /> <br /> D. 11ranch Clmul~ <br /> a) ~e fm for branch ~rcult~ with <br /> Each br~ ~ui~ ~ $ 2.00 <br /> b) The f~ for ~mch 6routs wi~out <br /> <br /> First branch circle <br /> Each add~6on~ branch clmult $2.00 <br /> <br /> E, Miscellaneous (Service or Fc~er Not Included) <br /> Bach ~mp or i~gafim drcle $40.00 __ 2 <br /> ~ach sign or mffinc llght~g __ $40.00 __ 2 <br /> Signal circuit(a) or a fi~d enemy <br /> ~nel, al~rafion or extmslon $40.00 <br /> <br /> E Each additional Insp~tlon <br /> <br /> a~ve, p~ ~s~c~ $35.00 <br /> <br /> Pack of 10 la~s ~ $5,00 each $50.00 <br /> Cold only to electrical co~ractor~) <br /> <br /> ( As required by ~uildlng Offlcla0 <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 /> B. l~nter 25% of llne A1 for Plan Review <br /> (Sec. 3), if mquired $ <br /> C. InvestigationFee (ff required) $ <br /> D- Rclnspcction Fcc ($25.00) $ <br /> <br /> TOTAl. AMOUNT DUE $ <br /> <br />MC 15-34 11/91 Receipt No, :: <br /> <br /> <br />