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FOR OFFICE USE ONLY I <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 Hig~h Street NE <br /> Salem, Oregon 97301 <br />Phone $gg-$147 8:00 am - 4:$0pm <br />Coda-A-Phono: 588-7904 <br /> FAX; 588-7948 <br /> <br />..... Please complete all Sections, I through 5 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />I. LOCATION OF INSTALLATION <br />Job Address~ <br /> <br />Pi~MIT5 ARE NON-'II~ANSFERABLE AND NON-REEUNDABLE A2qI) <br />EXPIRE IF WORK IS NOT STARTED WrlIIIN 180 DAYS OF iSSUANCE <br />OR 1/7 WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />PmpelW Owner <br /> <br />Mailing Addrcz~ <br /> <br />City/State/Zip <br /> <br />The installation is be~lg made on property [ own which is not in*prided for sale, <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will ~'o¥ide 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 tx'~wer calculations, plans, <br />nad specificahons when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />4. FEE SCHEDULE (Complete .*,nd enter total in Al below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A, <br /> Rt'-Sldenfial <br /> Per <br /> Unit <br /> Service Included: items Cost (each) Sum/ <br /> <br /> 1000 sq. fL or less $85,00 <br /> Each additional 5(10 sq. ft. <br /> or portion thereof $15.00 <br /> Limited Energy ~ $20.00 ~ ~ tJDh <br /> Each Manuf'd Home or Modular <br /> Dwelling Se~ice or Feeder $40.00 __ <br /> <br /> 200 amps ot less $50.00 <br /> 20I amps to 400 ampa $60.00 <br /> 40I aml~ to 600 amp~ $100,00 <br /> ~01 amps to 1000 am~ $130.00 -- <br /> Owr 1000 amps or volts $300.00 <br /> Rec(mnect ~mly $40.00 ~ <br /> <br />C, Temporary Servlces/F~flers <br /> <br /> 200 amps or less $S5,00 <br /> 201 amps ~o 400 am~ $40.00 <br /> 401 amps to 600 aml~ $80,00 <br /> Over 600 amps or 1000 volls <br /> <br />D, Branch Circuits <br /> New, Alteratlnn, or Exlension Per Panel <br /> <br /> a) Thc fee for branch circdits with <br /> <br /> Each branch circuit $2,00 <br /> <br /> b) Thc: f~ for bro, nch cimuts ~ <br /> ~lrehase of set,dee o~ feeder fee <br /> <br /> Fire branch circuit ~ $35.00 <br /> Each additional branch circ'.J.k $2.00 <br /> <br /> E, Miscellaneous (SerVice or Feeder Not Included) <br /> Each pump or iffi g a tiio,~ circle _ , SdO,O0 <br /> · Each sign or ou0ine hghfing .,, $40,00 <br /> <br /> panel, alte. ralion or extension $40.00 ~ <br /> <br /> above, pe~ Inspection $85.00 <br /> Pack of 10 labels @ Sd,00 each $50.00 <br /> <br />H. Other <br /> ~ AS required by [Jtlddiag Official) <br /> <br />5. FEES <br /> Al. Enter total of fees from S~c. #4 <br /> A2. Add $% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 2,5% of linc A1 for Plan l~.eview <br /> (Sec. 3? if mqhir'~,l <br /> C. Invest/gatlonFce (ff required) <br /> D. Rcinspuction Fca ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MC ].5-34 ]1/9] Receipt No, <br /> <br /> <br />