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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PE RM.iT APPLICATION ' <br />Please complete all'Sections, I through 5 <br /> <br />1- LOCATION OFINSTALLATION <br /> <br />MARION COUNTY BUILDINO INSPECTION <br /> 220 High Street NE <br /> <br /> ~-A-~e: f88-7~[ PermR No. <br /> <br />City <br /> <br />PERMrTS ARE NON.TRANSFERABLI~ AND NON-REFUNDABlE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR iF WOI:G( IS SUSPFg~[DED FOR lSO DAYS. <br /> <br />2A. CONTRACTOR INb'I'ALLATION ONLY <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />Propar~y Owner <br /> T <br />Ma[Ihls Address 1 Phone <br />CityjStateff. lp <br /> <br />The installadon [s being made on proper~ I own which is not ~nt*nded for sale, <br /> <br />3, PLAN REVIEW SECTION <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 the <br />rcqnired submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br /> 8 l O 0utql¥ ' <br /> Bg,!l rang iNS?ECtlON <br />4. ~E $CHEDUL~ (C~pletc ~d ~ter to~l ~ A 1 b~w) <br /> <br /> Number ~ lnsp~tions p~ permit allow~ <br /> <br />A. <br /> R~identlnl <br /> Per <br /> Unit <br /> / <br /> Se~lce Inctad~: It.s Cost (¢~h) <br /> <br /> Ea~ ad~ 5~ sq. g. <br /> m ~ffim ~e~of $15.00 <br /> ~ Ene $~.OO ~ 1 <br /> <br /> Dw~g Se~ or Fe~e~ $40,00 <br /> <br />B, Ser~s or Feeders ~oes no~ ~leu~ ~ch circuit, s~ section I)) <br /> <br />MC 15-34 11191 <br /> <br /> Installation, Alterations or Relocation <br /> 2.00 amps or less ~,50 O0 <br /> 201 amps to 400 amps v60100 <br /> 401 m'nps to 600 amps $100,00 <br /> 601 amps to 1000 amps $~80.00 <br /> Over lO00 amps or volt~ $S00.00 <br /> R~eonncat o~ly $40.00 <br /> <br />Telaporary Servlees/~eeder~ <br /> <br /> 200 amps of less $$5,00 <br /> 201 amps to 400 amps $40,00 <br /> 401 amps to 600 amps $130.00 <br /> Over 600 amps or I000 volts <br /> <br />~lranch Circuits <br /> <br />a) Th~ f~ for branch O. rc~its with <br /> <br />b) Th~ f~ for branch cArcu[s ~ <br /> <br /> Each pump or iirlgatlon circle $40,00 <br /> panel, alt*ration or extrusion $40,00 <br /> <br /> abo,~, per lnsp~on $3S,00 <br /> Pack c~ I0 lalml$ @ $5.00 each $$0,00 <br /> <br /> ( As r~qu&ed by Buildln$ OfflclaO <br /> <br />5. FEES <br /> Al. Ent*r total of fees from S¢c. #4 <br /> A2 Add 5% sumharge (05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Se.c. 3), if required <br /> C. ~nvcstigation l:ce 0~ required) <br /> D, Remspacticn Fee (825,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receip~ No. __ <br /> <br /> <br />