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FOR OF~FICE USE ONLY <br />ReCeived by: <br />Date: <br /> <br />i MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Snlem, Oregon 97301 <br /> Phone 588-5147 8:00 ~n - 4:30?m <br /> Code-A-Phone: 588-7904 <br /> PAX: 588-794g SITE #: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> 1, LOCATION OFINSTALLATION <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />..... gL...Z * ,, 'n ,.. e - ' 2" <br /> <br /> P~S ~E NON-~S~B~ ~D NON-~NDAB~ ~D <br /> E~E ~ WORK IS NOT STARTED ~ 180 DAYS OF ~SU~CE <br /> OR I~ WORK IS SUSPF~ED FOR 180 DAYS. <br /> <br /> 2A. CO~I'RAC'I'OR iNWFALLATION ONLY <br /> E,l~fi~,~~[racI°r ,~; /~ ~t ~o~lp~c ~///~ ~ <br /> <br />Contractors Board Reg. Nm ~ y~ ~ t.// lYob No- <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Pmlmny Owner <br />Mailing Addres~ Phone <br /> <br />Ciw/StatdZip <br /> <br />The img,',llalion is be. Jag made on propeay I own which is nO~ intended for gale, <br /> <br />Owners Signature <br /> <br />PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if yon complete Section <br /> 5B anti submit two (2) gets 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 />MC 15.34 11/9.1 <br /> <br />FEE SCHEDULE (Complete and enter total in A I below) <br /> <br /> Ser~ lCeln¢ Uded: Residen tia/iPer UnitNumber of Inspections..Per permit allowed <br />A. <br /> Itea~s C.o~t (each) Sum-- <br /> <br /> 1~ s , ft. or less $85.00 4 <br /> Each a~fi~d 5~ gq, fi, <br /> ~ ~ ~he~of $1 fi.00 <br /> ~it~d En~y $20,00 ~ 1 <br /> <br />Each Ma~ufd Home or Modular <br />Dwelling Se~ine or Feeder $40.00 <br /> <br />B. Services or Feeders (Doea not inleude branch ci reuit,% see ~ection D) <br /> <br /> 200 amps or less .... <br /> 201 ~rnps to 400 amps <br /> 401 romps vo 600 amps <br /> 601 amlp~s to 1000 amps <br /> <br />C. Temporary Services/Feeders <br /> <br /> 200 ~nps or in~s <br /> 201 :~'nps m 400 ~mps <br /> <br /> a) q~e fee for branch circuits with <br /> <br /> Each branch circuit ~ <br /> b) The fee for branch cireuts without <br /> purchase of 5ervlc¢ or 'feeder fee <br /> <br /> First branch circu~t <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Not ln¢in4ed) <br /> Each pump or jrfi gatlon circle __ <br /> Each. slgn. or. outline ling hting. <br /> <br />F. Each additional Inspection <br /> over the allowable in any of the <br /> <br />G. Mtnor Installatioii Labels <br /> Pack of I0 lairs @ $5.00 each <br /> <br /> [ A,v required Oy B~ildittg Offi¢ia0 <br /> <br />2 <br /> <br /> 50.00 <br /> <br />$100.00 <br />$180.00 __2 <br />$800.00 __ 2 <br />$40.00 __ 2 <br /> <br />$35.00 <br />$40.00 __2 <br />$80,00 <br /> <br />$2.00 ,~t'~ <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40.00 __2 <br />$40,00 __2 <br /> <br />$40,00 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> Al. F. nter total of fees from Sec, #4 <br /> A2, Add 5% s~rcharge (,05 xA1) <br /> <br /> Subtotal <br /> <br /> e. Enter 25% of line A1 for Plan Review <br /> (Sec, 3), if req~)isod <br /> C. ~vestjgationFe~ (d required) <br /> D, Rek~specfim Fee ($~,~) <br /> <br /> TOTAL AMOU~ DUE <br /> <br /> R~eipt No. <br /> <br />$ <br />$ <br /> <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />