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FOR OFFICE USE ONLY <br />Received by: , ' · <br />Date: 7 ,, <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> 220 High Stxeet NE, <br /> <br /> SITE#: ~p <br /> <br />Phona 588-5147 8;00 ~n - 4:30pm <br />Code-A-Phoae: 558-7904 <br /> FaX: 588-7948 <br /> <br />lELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />t, t.O *T,ONOFtN ALLAT ON '73 -o3/3k5 <br /> <br />PERMITS ARE NON -IF, AN$1~'I~RABLE AND NON-KEFUNDAB LE AND <br />EXPIRE IF WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 1 S0 DAYS. <br /> <br />2A, CONTRACTOR INb'TALLATION ONLY <br /> <br />Pm~ny Owner <br /> <br /> Job No <br /> <br />[Pho~ne No. <br /> <br />S~atum af Supcnds~ng Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Ownar <br />Ma~ling Address Phone <br />City/StateffJp <br /> <br />Thc installation is being made on pcopetty ! c~vn winch i$ not intended for sale. <br />lease, or rent. <br /> <br />Owner's Signature . . <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 plaos and specifications Mth <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 /> Date: ~'"' ............ <br /> <br /> Issued by: I~UILDING IN~PFP. TIQN <br /> <br />4, bEE SCHEDULE (CmnpIete and ~ter to~] ~ A 1 ~OW) <br /> <br />A. <br /> R~idenflal <br /> ~r <br /> UnR <br /> S~1~ Include: It~a C~t (each) <br /> 1~ sq. ~ or Iaaa $85,00 <br /> <br /> ~d ~y $20.00 <br /> ga~ ~u~d H~* or M~u~r <br /> Dw~ng Sc~ m Fc~ $40,00 <br /> <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 601 ampalto 1000 amps <br /> <br />C. Temporary Servlces/Fee~ers <br /> Installation, Alteration, or R~loeation <br /> <br /> 201 amps to 400 amps <br /> 401 am sto600am <br /> Ov,r~ amp~ or 1~0 volt~ <br /> <br />D- Branch Circuits <br /> <br /> a) The fee fcc brmaell c~rcuils wilh <br /> <br /> · Each branch lfircuil <br /> <br /> b) The fee for branch drcut, without <br /> <br /> (As req~red by Building Offwia0 <br /> <br />50.00 <br /> o.oo <br />$100.00 __ 2 <br />$130.00 __2 <br />$300.00 2 <br />$40.00 -- 2 <br /> <br />$35,00 <br />$40,00 __2 <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 />$$0.00 <br /> <br />5. FEES <br /> A 1. Enter to~al of fees from Sec, 644 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Entet25%ofliaeA1 for Plan R~view <br /> (S~, 3). if require3 <br /> C, Investigation Fee (if required) <br /> D. Relnspecti~m Fee 0;25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MC 15-34 11/91 Receipt No. <br /> <br /> <br />