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iFOR OEFICE USE ONLY <br />Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 240 Higl~St~ect NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 5S$-5147 8:00 a~ - 4:30pm <br /> Code-A-Ph~g~ 588-7904 <br /> FAX: :~88-7~8 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATI°N <br />Please complete all Sections, i through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />L LOCATION OFINSTALLATION <br /> <br />De~,tpaon ~0 ~J,~r~ ~ ....... <br /> <br />P~RMITS AR~ NON-'i~N~BL~ ~D NON-~NDAB~ <br />E~E IF WORK ~S NOT STATED ~.~ 180 DAYS OF <br />OR ~F WORK IS SUSP~DED FOR 180 DAYS. <br /> <br />2A. CO~OR IN~ALLATION ONLY <br /> C. <br /> <br />4, FEE SCHEDULE (Complete and enter total ~n A1 b~low) <br /> <br />MaR~tg Address <br /> <br />Owners Signature <br /> <br />PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Secfon <br /> 5B and submit two (2) sets of plaes and specifications with <br /> this application, <br /> <br />This optional plan review pn~gcam does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oxegon Structural <br />Specially Code, Chapter 53, <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: i;eans Cost (~ch) Sum/ <br /> <br />10~ sq- fL or less $85.00 <br />Each a~difion~ ~ sq, <br />or ~ the~of $ ~ 5,00 <br />MIOd Enc~y $20.00 <br /> <br />Each MantLPd Home or Modular <br />Dwelling SeaMc~ or Feede~ $40,00 <br /> <br /> 50.00 <br /> 200 amps or less $ $60,00 <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps StO0, O0 <br /> 601 amps m 1000 amps __ $130.00 <br /> Over 1000 a~ps or volta $S00,00 <br /> Re~a~eet only $40,00 <br /> <br /> 200 amps or less $;~,00 <br /> ~01 ~-nps to 400 amps $~0,00 <br /> 401 amtopi s to 600 amps $80,00 <br /> Over 600 amps or I0~ volta <br /> <br />R Each additional InspeCtion <br /> above, per Inspection <br /> <br />G, Minor Installation Labels <br /> Pack of 10 labels @ $5,00 each <br /> (sold only to electrical contractors) <br /> <br />H. Other <br /> ( As req~dred by Building Official) <br /> <br />New, Alteration, or Eateaslon Per Panel <br /> <br />a) Thc fee f~ ~anch 6teu~ts with <br /> <br />g. FEES <br /> <br /> A I, Enter total of fees from Sec, #4 <br /> A~, Add 5% surcharge (,0~ x A 1) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of line A 1 for Plan Review <br /> (See, 3), if <br /> C* ~vcst~afion~ee (~qu~d) <br /> D, Re~s~m Fee ~,00) <br /> <br /> q~TAL AMO~ <br /> <br />$2,00 <br /> <br />$35,00 <br /> $2.00 __ <br /> <br />$40.00 <br />$40.00 <br /> <br />$40,00 <br /> <br />$85,00 <br /> <br />$5o.oo <br /> <br />MC 15-34 11/91 Receipt No. <br /> <br /> <br />