Laserfiche WebLink
FOR OFFICE USE ONLY <br />I Received by: <br /> Date:_ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-51478:00 am - 4:30pm <br />Cede.A.Phone: 588.7904 <br />tAX: 588-7945 <br /> <br /> I <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> I <br /> <br />Date: MARI~I',/Phi ~TV <br /> <br />Issue6 By: <br /> <br />1. LOCATION OF INSTALLATION <br />Ioh Address /x~ ~) q5 ~/ <br /> <br />ICross St. <br /> <br />PEILM1TS ARE NON-TP, ANSFERABLE AND NON-RI~I%INDABLE AND <br />EXPIRE IF WORK I5 NOT STARTED WTII~ 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Electrical Ccatra¢[or <br /> <br />IPhone <br /> <br />Mailing Address <br />Property Owner I Phone <br />Contractors Lites se No, <br />Cont/actol~s Boa~l Reg. No. [/ob No. <br /> <br />2B. FOR OWNER IN5TAI,LATIONS <br /> <br />~ inst~a~ is ~$ ma~ ua p~ l ~a WM~ is n~ Mmnd~ for a~o, <br />PLAN RgVi~W SE~ION <br /> <br />We will provide plan rev/eT se~wice 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 requirc.3 by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15.34 11/91 <br /> <br />4, FEE SCHEDULE (Complete and e~et total i~ A l below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> I <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> 1000 sq. ft. or less $85.00 4 <br /> Each additionel 500 sq. <br /> or rtioa thereof $15,00 <br /> Lirrfite~°~c~y __ <br /> $20.00 <br /> Each Manta'd Home o~ Mextuhr <br /> Dwelling Service or Feeder $40.00 __ 2 <br /> <br />B, Services or Feeders (Does not inlcJde branch circuits, sec section D) <br /> Installaflon~ Alterations or Relocationt <br /> 200 aml~ or leas ~ $$501005000 . . <br /> 201 ~mp~ to 400 amps -- 2 <br /> 401 amps ~o 600 amps $~00.00 __ 2 <br /> 601ampad. [o lO00 amps $1~0.00 __ 2 <br /> Over 1000 amps or volts $800.00 __ 2 <br /> Reconnect o~lly $40.00 __ 2 <br /> <br />C, Temporary Services/Feeders <br />lnstallation~ Alteration, or Relocation <br />200 amps or less $88.00 <br />201 amps to 400 amps $40.00 <br />401 ammpa s to 600 am~ $130.00 <br />Over 600 amps or 1000 volts <br /> <br />D. Branch Circuits <br /> <br /> a) The f~ for bra~ch O. reuits with <br /> purchase of aervlce or feed~ <br /> Each branch uimint ~-~- $2,00 <br /> b) The fm for b~anch C/roOts without <br /> <br />First brach circuit <br />Each additional branch circuit $2,00 <br />Ih', Miscellaneous (Service or Fe~der Not Included) <br />Each pump or irrigation circle $40.00 <br /> Each sign or ouflinc I!~htJ~g , SAO.00 <br /> ~ignal circuit(s) or a limited energy <br /> panel, alteration or extension $40.00 <br /> <br />F. Each additional Inspection <br />over the allowable in any of the <br />above, i~t Inspection $35.00 <br /> <br />G, Minor Installation Labels <br /> Pack of 10 labels @ $5,00 cach__ $50.00 <br /> <br />H. Other <br /> ( Ac recleireE &y Bailding Official) <br /> <br />~. FEES <br /> Al, ]inter total of fees from Sea #4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Eater 25% of line A 1 for Plan Review <br /> (Sec, 3). if required $ <br /> C. Inveat~gaUonFee (if required) $ <br /> D, P,~inspectien F~ ($25.00) $ <br /> TOTAL AMOUNT DUE $ ff'~ ~ <br /> <br />Receipt No, . .... <br /> <br />2 <br /> <br /> <br />