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IFOR OFFICE USE ONLY
<br /> Received by.'.
<br /> Date:
<br />
<br />I ELECTRiCAI- PERMIT APPEICATIoiq'~" '
<br /> P/ease comp/ete al~ Sections, I through 5
<br />
<br />MARION COUNTYtlJJILDING INSPECTION
<br /> ¥
<br /> '220 High Stree~ NE
<br /> Salem, Oregon 97301
<br />
<br /> Phcme 588-5147 8:00 mu - 4:30pm
<br /> Code-A-Phone: $88-7904
<br /> FA~: 588.7948
<br />
<br />PEKM1TS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND
<br />F~XPIRE IF WORK I$ NOT STARTED WITHI~ 180 DAYS OF ISSUANCE
<br />OR IF WORK IS SUSPENDED FOR 180 DAYS.
<br />
<br />2A. CONTRACTOR INSTALLATION ONLY
<br />
<br />2B. FOR OWNER INSTALLATIONS
<br />Property Owner
<br />
<br />Ma~ng Address Phone
<br />City/State,rZip
<br />
<br />The installation is being made on property I own which is po~ intendot for sale,
<br />
<br /> Owners $1gnamre ............
<br />
<br />'"2. PLAN REVIEW SECTION
<br />
<br /> We will provide plan review service if you complete Section
<br /> 5B and submit two (2) sets of plans and specifications with
<br /> this application.
<br />
<br />This optional plan review program does not suspend the
<br />required submission of lighting pOwer calculations, plans,
<br />and specifications when required by thc Oregon Structural
<br />Specialty Code, Chapter 53.
<br />
<br />MC 15-34 ll/gl
<br />
<br />SITE #:
<br />Date: ~[/~ 0 ,~,,,,,,,,,t~$
<br />
<br />4, FEE SCHEDULE (Complete ~d enter total in A1 below)
<br />
<br /> Per
<br /> Unit
<br /> /
<br />
<br />1000 sq, 1~ ot less $85,00
<br />
<br /> or porfi,m ~he~-of $15.00
<br />Limited Eneag,y.. $20.00 __ 1
<br />
<br /> Dwellins Service or Feeder Sd0,00 2
<br />
<br />B, Services or Feeders (Does not ~nlcade bra~h eircui[s, se~ section D)
<br />
<br /> 200mupsorless /3 f~- ~"' $50,00 --,2
<br /> 201 amps to 400 amps J] [/~ . $60,00 -- 2
<br /> 401 amps to600amps I/,, ,,i.~ ~tO0,O0 -- 2
<br /> Overl000~apsor¥olts '/2 ~.,/,,,~.._~,,~' $300,00 __ 2
<br />
<br />$3.5.00 ---~,,~ 2
<br />$40.00 __2
<br />$80.00 __2
<br />
<br />$2,00
<br />
<br />$85.00
<br /> $zoo
<br />
<br />$40,00
<br />sa0,00
<br />
<br />$40.00 2
<br />
<br />C. Temporary Selwlces/F~defs
<br /> InstallaUon, Alteration, or Relocation
<br /> 2~ ~ps or less /'--
<br /> 201 ~ps to ~0 am~
<br /> 401 ~p~ m ~ ~
<br /> .... ~ps or l~ volt~
<br /> sm B above
<br />
<br />D. Branch Cireui[q
<br /> New, AIt~atlon, or P~tension Per Panel
<br />
<br /> Each ~mp ~ i~ga~ ~ircle
<br />
<br /> S~n~ c~aitO) or a ~d
<br />
<br /> ~er~e ~owable ~ any
<br />
<br /> Pack ~ 10 h~s ~ SS.00
<br />
<br />~. Other
<br /> ( ~ ~q~red ~ BuiMin8
<br />
<br />$35.00
<br />
<br />$50.00
<br />
<br />Al. Pm,=, total of fees from Sec. #4
<br /> A2. Ada ~% surcha~e (.05 x Al)
<br />
<br /> Sub~l
<br />
<br /> B, gn~r ~% of ~e A 1 for ~an Review
<br /> (S<. 3), ~ m~
<br />C.~vest~ali~ Fee (~mquired)
<br />D.~pmfim Fe* ($~.00)
<br />
<br /> WTAL AMOU~ DUE
<br />
<br />Receipt No, ,
<br />
<br />
<br />
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