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FOR OFFICE USE ONLY <br />Received by:_ ~ <br />Date:..__~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Sll-eet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88-5147 $:00 am - 4:$0pm <br /> Code-A-l~one: 588-7904 <br /> FAX: 588.7948 <br />ELECTRICAL PEFIMIT APPLICATION / <br />Please c~rnplgto all Seations, 1through 5] <br /> <br />SITE #: <br /> <br />Issued ~yU~il~6f~G INSPECTION <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directions <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON.REFUNDABLE AND <br />EXPIP. E 1F WORK IS NOT s'rARTED W1THIN 180 DAYS OF ISSUANCt~ <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRAC~FOR iNKrALLATION ONLY <br /> <br />34, xy. .. ] ho"eNo. 70-7 <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Properly Owner <br /> <br />MaJ]mg Address <br /> <br />Ci~y/S[atefZip <br /> <br />The imtallation i~ Ming made cai properW I own which is not intended for sols. <br /> <br />Ownees Signature <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 />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 SCHEDULE (Complete ~nd enter tote[ in A 1 below) <br /> Number of lnspcmtions per permit allowed '"1 <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: h~xns C~t (each) Sum <br /> <br />1000 sq. f~ or less $8500 __ 4 <br />Each add[fiona, t ~00 <br />or purde~ thereof $16,00 <br />Limited ~ne~gy $20,00 -- 1 <br />Each Manafd ltom~ or Modular <br />Dwelling Servic~ or Feeder <br /> <br /> 200 amps or less <br /> 201 amps ~o 4~0 snaps <br /> 401 am~ to 600 amps <br /> 601 amps to 1000 amps <br /> Over 1000 amps or volt~ <br /> Reconnect <br /> <br /> Installation, Alteration, or Relo~atio~ <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 am sto6OOam s <br /> <br />a) The fee for branch circuits with <br /> <br /> Each branch ¢imuk <br /> <br />b) The fee for branch cireats without <br /> <br /> Each additional branch cimult <br /> <br /> Each pump or irrJgattota circle <br /> Each ~irda or outilne Ii~htlng <br /> Signal ¢,i~uiffs) or a limited enemy <br /> <br /> ~ver the allowable in any of <br /> above, per Inspection <br /> <br /> Pack of 10 lal~l$ @ $.5,00 each <br /> (void only to electrical contractors) .... <br /> <br />Other <br /> ( As required by Bailding Offie~a0 <br /> <br />50.00 <br />~60,00 <br />$100,00 <br />$100,00 <br />$300,00 <br />$40,00 <br /> <br />$35.00 2 <br />$40.00 <br />$60,00 __2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40.00 --2 <br />$40.00 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> A 1. Enter tclal of fees f~om Sec, #4 <br /> A2. Add 5% surchaege (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec, 3), if required <br /> ~. lnvestigationFee (/f required) <br /> D. Reinspe~tinn Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No.: ............ <br /> <br /> <br />