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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 }'Iigh Street NE <br /> Salem, Orego'fl 97301 <br /> <br /> Phone 58S-5147 S:00 am - 4:30ptn <br /> Code-A -Phone: 588-7904 <br /> FAX: 58S-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> I <br />Please complete all Sections, I through 5 <br /> <br />Issued ~JJ ~t~n ,.,g .... <br /> ........ 'orcuIIUN <br /> <br />1. LOCATION OFINSTALLATION <br /> <br /> / ~, 7- <br /> ' ' r ~J <br />DircCtions <br /> <br />PERM11 S ARE NON - I~S~BLE ~D NON-~AB ~ ~ <br />~X~E ~ WORK IS NOT STAR~ W~ 180 DAYS OF ISSU~C~ <br />OR ~ WORK IS SUSPE~ED FOR 180 DAYS. <br /> <br />23. CONTRACTOR INSTALLATION ONLY <br />ElectticM Contraomr <br /> <br />06.7( <br /> <br />lob NO, <br /> <br />Signature of Supervls~g Elect delan'7~~~.~.~.~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mailing Address Phone <br /> <br />City/State/Zip <br /> <br />The installation is I~eing made on property I own which is n~t intended for sale,. <br /> <br />Owrle[s SJsnatum <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will pro¥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 power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53- <br /> <br />4. FEE SCHEDULE (Complete sod enter toad in A l below) <br /> <br />$85.00 , 4 <br /> <br />A. Residential Per Unit <br /> <br />1000 sq, fl, or less <br />Each additional 500 sq. ft. <br />or posen thereof $15.00 <br />Limited Energy'"' $20.00 <br />[~ach Manafd l-lorac or Modular <br />Dwelling Se~ee or Feeder $40.00 <br /> <br />B. S~rvlces or Feeders (Does not inlc~de branch circuits, see ~cctlon <br /> <br /> 200 amps or less /' $50.00 <br /> 201 aml~ to 400 araps $60,00 <br /> 401 ampi to 600 arapa $100.00 <br /> 601 araps to 1000 amps $130.00 <br /> Over I000 m-nps or volts $S00.00 <br /> Reconnect only $40,00 <br /> <br /> 200 amp~ et less $35.00 <br /> 201 amps to 400 amps $40.00 <br /> 401 amps to 600 amps $80.00 <br /> Over ~6~,,0 amps or 1000 volta <br /> <br /> a) 'Die ~ee for branch circuits with <br /> p. gyehasc of servi~ o~ J[.e. qA e r fcc <br /> <br /> Each branch c/muir __ $2.00 <br /> <br /> b)The fe~ for branch ~muts without <br /> purchase of servioe or fccde[,,f~¢ <br /> <br /> First htalach circuit $3S.00 <br /> Each additional branch circuit $2,00 <br /> <br />E. Miscellaneous (Service or Feeder Not InclUded) <br /> Each pump or irrigation circle .~ $40,00 <br /> Each sign or out/thc l!~ghfing $40.00 <br /> Signal eitclliffs) or a limited e~etgy <br /> <br />F. Each addltional Inspection <br />over the allowable in any of the <br />above, per ~spuction $85.00 <br /> <br />G. Minor Installation Labels <br />Pack of I 0 ldae/s @ $5.00 each $50,00 <br />(sold only ~o eI~ctrlcal contractors) <br /> <br />ti, Oth~r <br /> ( A~ required by SuEd[nB Offlch:0 <br /> <br />5. FEES <br /> Al. Enter total of fee~ fwm See, #4 · $ <br /> A2. Add 3% surcharge (.05 x Al) $,, <br /> <br /> Subtotal $ <br /> <br /> FJ, Enter 25% of llne A1 for Plan Review <br /> (See. 3), if mqtfifi~l <br /> (2. InvcstlgationFee (d mqulmd) $ <br /> D. Reinspeclion Fee ($2.5.00) $ <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MC 15-34 ll/9J Receipt No. <br /> <br /> <br />