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FOR OFFICE USE ONLY <br />Received by:_ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />ELECTRJ'~AL PERMIT APPLICATION'::":" <br />Please complete all Sections, i through,5! <br /> <br /> 220 ~Iigh Street NE <br />Salem, Oregon 97301 ~.~ ,'~ <br /> <br /> Date; <br /> <br /> 4. ~E SCHEDULE (C~plete ~¢~n~r total ~ A I bc~w) <br /> <br /> A, <br /> R~idenflal <br /> Per <br /> Unit <br /> Semite Included: It--s Cost (e~) S~ <br /> <br /> 1~ sq, ~, ~ less <br /> E~h ad~nal 5~ sq, <br /> ~ ~ t~of $ ~ 5,00 <br /> ~i~d ~ne~y <br /> <br /> ~ S~ or F~d~ $40.00 ~ 2 <br /> 2~ amps or less <br /> <br />L LOCATION OF INSTALLATION <br /> <br />PERMYFS ARE NON-'IRANSFERABLE AND NON-REFUNDABL~ AND <br />EXPIRE ~ WORK iS NOT STARTED W~TI-I~ 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 150 DAYS, <br /> <br />2A. CONTRACTOR INb~I'ALLATION ONLY <br /> <br />2IL FOR OWNER INSTALLATIONS <br /> <br />Mailing AddresS1~ <br />City/State/%ip <br /> <br />The in~t~/ladon is being made on property I own wliich is not intended for sale. <br /> <br />Owner s Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you ~omplete S~Qon <br /> 5B and submit two (2) sets of plans and s1:~cificatlons wRh <br /> this appHcaQon. <br /> <br />This optional p/an review progr',un does not suspend the <br />requited 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 11/97 <br /> <br /> 201 amps to 400 ~mps .... <br /> 401 amps to 600 arnp~ <br /> 601 amps to 1000 aml~ <br /> <br /> Recoraa¢ct c~ly <br /> <br /> C. Temporary Services/Feeders <br /> <br /> 200 amps ot less $,~,00 <br /> 201 amps to 400 amps Sd0,00 <br /> 401 am ato600a~ps $80.00 <br /> Over 6~ amps or 1000 volts <br />New, AIteratlon~ or E~enslel~ Per Panel <br /> ranch Circults <br /> <br /> a) The f~ for beaneh 6mu~ts <br /> purcha~ 9f set~hc~ ~-,fecder <br /> Each brach eirculi 2-~ $2,00 <br /> <br /> b) The fed for branch elreut~ ,without <br /> marehase of %¢rviee or f¢~der fee <br /> <br /> Fi~t branch eireuli <br /> Each additional branch circuit SZ00 <br /> <br /> E. Miaealleneous (Service or Feeder Not Iyeluded) <br /> Each pump or irrlgadon circle i' $40.00 <br /> Each sign or oa~ine lighting __ $40.00 <br /> Signal eircali(s) or a beal~ed energy <br /> panel, alteration or extension __ $40.00 <br /> <br /> F. Each a~dltlenal Inspection <br /> over the allowable in any of the <br /> above, per Inspoetlon $35.00 <br /> <br /> G, Minor Instollaiion Labels <br /> Pack of 10 labels @ $5.00 each $S0.00 <br /> (sold only to electrical contractors) <br /> <br />H. O~ber <br /> (As r~quired by Building Official) <br /> <br /> 5, FEES <br /> Al. Enler total of fees from Sec, #4 <br /> A2. Add 5% surchargn (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (S~c. 3), if required $ <br /> C, Invesfi§adon Fcc (if required) $ <br /> D, R~impcctica Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />~O, 2 <br />__2 <br /> <br />--2 <br />__2 <br /> <br /> 2 <br /> 2 <br />--2 <br /> <br /> ~50,00 <br /> 60.00 <br />$100,00 <br />$130,00 <br />$300,00 <br /> $40,00 <br /> <br />$ qq.a c <br /> <br />$ <br /> <br />--2 <br /> <br />$ <br /> <br /> <br />