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FOR OFFICE USE ONLY <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 22o High Steer NE <br /> Salem, Oregon 97301 <br /> Ph~nc 588-5147 8:{]0 ~n - 4~0pm <br /> Codc-A-l:'h,~c: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OFINSTALLAT~ON <br /> <br />REEIV£ <br /> <br />C~s~. <br /> <br />2 6 <br /> <br />PEK~I'I~ ARa NON-'fRANSFERABLE AND NON-RE~AB~ A~ <br />EXP~E IF WORK IS NOT STARTED ~ I80 DAYS OF ~SUANCE <br />OR IF WORK IS SUSP~ED FOR 180 DAYS. <br /> <br />2A. CO~RA~OR IN~ALLATION ONLY <br /> <br />COt <br />NSF <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />MC 15-34 11191 <br /> <br /> Dv,~]]ing Sem, i~ or Feed~ $40.00 2 <br /> <br /> Installation, Alterations o~ RelOcation I ~)~ <br /> 2~ am~ O~ less l $50,00 ,~ - '- ~ <br /> ~1 am~ ~ 4~ amp~ $60,00 ~ <br /> ~1 am~ to ~ amps $100.~ 2 <br /> ~1 am~ ~ 1~ am~ $130.~ ~ 2 <br /> ~er I~ ~ps or rahs $300.~ 2 <br /> R~ect ~ $~.00 2 <br /> <br />C. Tem~rary Servicings <br /> Ins~lle6on, Alt~atlon, or Rel~atlon <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Pml~r,y Owner <br />Marling Address Phone <br /> <br />C~ty/St at¢/~'tp <br /> <br />The ~st~a~n is ~g made ~ p~ay I ~n w~ is n~ ~ded for s~e. <br /> <br />3. PLAN REVIEW S~'['[ON <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code. Chapter 53. <br /> <br /> 201 ~mps to 400 ampa <br /> 401 ~aps to 600 aml~ <br /> Over 600 amps or 1000 volts <br /> <br /> pumh~se ~ se~ ~ fe~er fcc <br /> <br /> F~t branch <br /> ~ addid~ brach c~t <br /> <br />E. Miscellan~us (Service or Feeder Not Included) <br /> ~ch ~mp or ~gaa~ cite <br /> <br /> S~n~ ~t(s) or a <br /> <br />G. Minor ins~llaaon La~Is <br /> Pack of 10 la~s <br /> (~ld o~y to electrical cad,tars) <br /> <br />~_ Oth~ <br /> ( As req~md by Building Offic~l} <br /> <br />5. FEES <br /> Al. Enrac ~al of f~s from S~. <br /> A2. Add 5% ~umha~c (.05 x Al) <br /> <br /> Subm~ <br /> <br /> B. ~nmr ~% of ~e A I for P~ Review <br /> <br /> C. ~v~t~atlon Fee (ff ~ff~d) <br /> D. R~s~ Fee ($~) <br /> <br /> ~TAL AMOU~ DUE <br /> <br />, Re. cei~t No, _ <br /> <br />$85,00 <br />$40,00 <br />$80,00 <br /> <br />$S5.00 <br /> $2,00 <br /> <br />40,00 2 <br />40.00 2 <br /> <br />$40.00 __ 2 <br /> <br />$35.00 __ <br />SS0.00 <br /> <br />N~¢3VE E SCHEDULE (Coraplcte and enter total in A 1 below) <br />EC'flON <br /> A. R~lde#ttal Per <br /> Semite Include: It~s C~t (~ch) Sum <br /> <br /> 1 ~ s~ ~ ~ less $85,00 ~ 4 <br /> E~h a~6oaal 5~ ~q. ft. <br /> ~ ~ t~mof $ ~ 5.00 <br /> ~ ~ne~y $~0.00 <br /> <br /> <br />