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FOR OFFICE USE ONLY
<br />Received by:
<br />Date:
<br />
<br />MARION COUNTRY BUILDING INSPECTION
<br /> 22O High SO,et NE
<br /> Salem, Oregon 97301
<br />
<br /> Phone 588-5147 8:00 am. 4:30pm
<br /> Co,e-A-Phone: 588-7904
<br /> FAX: 585-7948 SITE #:
<br />
<br />ELECTRICAL PERMIT APPLICATION"
<br />Please complete all Sections, I through 5
<br />
<br />1. LOCATION OFINSTALLATION
<br />
<br />Directions
<br />
<br />PBRM1TS ARE NON .'tRANSFERABLE AND NON-REFUNDABLE AND
<br />EXPIllE IF WORK IS NOT STARTED ~ 180 DAYS OF ISSUANCE
<br />OR IF WORK IS SUSPSNDBD FOR 180 DAYS.
<br />
<br />211. FOR OIVNER INSTALLATIONS
<br />
<br />Pmper*y Owner
<br />Ma~s Address Phone
<br />Cky/State/Zip
<br />
<br />'l~e instalhdon is being made On property I own which is ~lOt intended for sel~,
<br />
<br />3. PLAN REVIEW SECTION
<br />
<br />We will provide plan review service if you complete Section
<br />58 and submit two (2) sets of plans and specifications wilh
<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 Struct~al
<br />Spcciahy Code, Chapter 53,
<br />
<br />MC 15.34 11/91
<br />
<br />Date:
<br />
<br />Permit No.
<br />
<br /> Issued by:
<br />
<br />FEE SCHEDULE (Complete and enter total in Al below)
<br />
<br />A, Residential Per Unit
<br /> Service Included:
<br />
<br /> 1000 aq, ft. or less
<br />Each additional 500 sq, ft,
<br /> or portion thereof
<br />
<br />$85.00
<br />
<br />$15,00
<br />$20,00
<br />
<br />Each Manufd Home or Mc~uhr
<br />Dwelling Service or Feeder /0~ $40,00
<br />
<br />B, Services or Feeders (Does not inlcude branch ¢{teuita, sec section D)
<br />
<br /> Installation, Alteration~ or Relocation
<br />
<br /> 201 amps to 400 amps
<br /> 40I amps to (<10 amps
<br /> 601 aml~ to 1O00 amps
<br />
<br />12, Temporary S¢,tvicea/F~aers
<br />
<br /> 200 amps or l~ss
<br /> 201 amps to 400 amps
<br />
<br /> OVor 600 amp~ or I000 volts
<br />
<br />D, Branch Circuits
<br />
<br /> a) Thc fee for branch ~rcdita wah
<br />
<br /> Eaoh branch cfi-cult ~
<br /> b) The fcc for branch c, lrcms without
<br />
<br /> ]:ach ad~lifional braoch <ircuJt .,
<br />
<br />P,. Mtseel{a#cous (Sarvice or P~der Not tn¢{uded)
<br /> F.~h 13xmp or irrigation circle
<br /> Each sign or outli~e lighting .,
<br /> Signal circuit(s) or a llmiled encrgy
<br />
<br />F. Each additional hlspcetlon
<br /> over the allowable in any of the
<br /> above, per Inq~ection
<br />
<br />G, MI#or Installation Labels
<br /> Pack of l0 labels ~ $$,00 each ,,,
<br /> (sold oMy tO electrical contractors)
<br />
<br />H, Other
<br /> (AS r~quirad by Building Off-~ia0
<br />
<br /> $50.00 ..... 2
<br /> $60,00 ,, 2
<br />$100.00 2
<br />$130.00
<br />$300.00 __ 2
<br /> $40.00 ~ 2
<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 Z
<br />$40.00 --2
<br />
<br />$40.00 2
<br />
<br />$35,00
<br />
<br />$60.00
<br />
<br />5. FEES
<br />
<br /> (See, 3), if recl_u~ r~i
<br /> C. InvestJgadonFee (ff rr. quimd)
<br /> D. Reinsi~ctic~ Fee ¢$25,00)
<br />
<br />$
<br />
<br />$,.,,q~8, -*o
<br />
<br />.... Receipt No, ,,
<br />
<br />
<br />
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