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Received by: ...... <br />Date: ......... <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Stxeet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 5~.794S SITE #; <br /> <br />1. LOCATION OFIN~I'ALLATION <br /> <br />i:' ER~,iYl'5 AKE NON-~ANS~BLE ,~D NON-~FU~AB~ ~ <br />E~E IF WORK IS NOT S'IA~I'ED ~'llI~ 180 DAYS OF ISSUANCE <br />OR ~ WORK IS SUSPeNDeD bOR 180 DAYS. <br /> <br />FOR OWNER INSTALLKFIONS <br /> <br />pmr~rty Owtt~r <br /> <br />City/State/Zip <br /> <br />PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Sacfiort <br /> 5B and submit two (2) sets of plans and specifications with <br /> this application. <br /> <br /> This optional phm review program does not suspend the <br /> required submission of light/ns !yawer calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />~C 15-34 11/91 <br /> <br />Date: <br /> <br />PermitNo. <br /> <br /> Issued by: <br /> <br />4, YEE SCHEDULE (Complete ired enmr tou*l itl A1 below) <br /> <br /> Number of lnspacthm$ per permit allowed <br /> <br />A, <br /> R~idenflal <br /> Per <br /> Unit <br /> Se~ice Included: Items Cost (each) Sum/ <br /> <br />I0~ sq. ft. ~ l~ss $85,00 ~ <br />Each ad~on~ 5~ sq, ft. <br />~ thereof $15.00 <br />L~iled Energy ~ $20,00 <br />Ea~ Manned }lo~o or M~r <br /> <br />g. Ser~s or Feeders (Docs no~ ~Icude bratlch clmnita, sec ~ct/on D) <br /> ina~lhtlo~ Alterations or <br /> <br /> 201 amps to 40(I amps <br /> 4OI am~ to 600 ampi <br /> 601 amp~ to I000 amps <br /> OVer I000 tamps or volts <br /> <br /> 200 amps or less <br /> <br /> 40l amps to 6(10 amps <br /> OVer 600 gmp~ or 1000 volts <br /> <br />D, Branch Circuits <br /> <br /> a) '/'he fee for branch <br /> ~c~ o~ feeder fcc <br /> <br /> b) 1]~* l~e for branch elrcut$ <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pt~mp or fr~ Baden circle <br /> Each sign or omEn¢ Egl~dag <br /> Signal ¢{muit(~) or a Hro. itcd ertergy <br /> <br />F. Each additional Inspection <br /> over the allowable in aQy of the <br /> above, per h~eetlon <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels ~ $5,00 each <br /> <br />H, Other <br /> ( A,* r~qmred by Buildi~g DfflciaO <br /> <br /> ~5o.o0 --2 <br /> 60.00 ~ <br /> <br />$300.00 -- 2 <br />$40,00 ~ <br /> <br />$35,00 <br />$40,00 <br />$80,00 <br /> <br />$2,00 __ <br /> <br />$35,00 <br /> $2,00 <br /> <br />$40,00 <br />$40.00 <br /> <br />$40.00 __2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />Al. ,qmor total of fees from S¢c, #4 <br />A2, Add 5% mrcharg¢ (,05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of llne A1 for Plan Review <br /> (Sec. 3), if <br />C, Investigation l%e (if requir0d) <br />D, Reinspeed~ Fee <br /> <br /> ~YfA L AMOU~ DUE <br /> <br />Re~i¢ <br /> <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />