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I OR O. ON'.Y ] <br /> Received b y~ff_J~ ~ [ <br /> Date:~ J <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Start NE ~ <br /> Salem, Oregon 97301 {t~ <br /> <br /> Phone 585-5147 8:00 m~n - 4:30p~ <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 $1TE #: <br /> <br />E L'ECTRlCAL' P E R[~/~ IT ApIpLICAT'ON ~ <br />Please complete all Sections, I through 5J <br /> <br />1, LOCATION OFXNSTALLATION <br /> <br />~E ~ WO~ I~ NOT ~ ~ 180 DAYS OF <br />O~ ~ WORK I~ SUS~BD FO~ 180 DAYS. <br /> <br />2A; CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical COBtraetor <br /> <br />Mailing Addrcas <br /> <br /> Owner J Phone <br />property <br /> <br />Eona'a~ofs ~cmsc No. <br /> <br />~t~fs Boa~ ~g. No. [~ob <br /> No. <br /> <br />S~tu~ of Su~smg ~n~ <br />$upe~sofs ~se No, Ph~e <br /> <br /> B. FOR OWNER INSTALLATIONS <br /> <br />~e ~a~ ~ ~$ ma~ ~ ~ [ ~n wMch xs n~ m~dad for <br /> <br /> PLAN RE~W $E~ION ' ~ <br /> <br /> We wffi pmyi~ pl~ rofiew ~c¢ if you complete S~fion <br /> 3B ~d submit ~o (2) ~ of plans ~ sp~cafions <br /> ~is application. <br /> <br />This op$ional plan review program does not suspend the <br />required submission of lighting power calculations; plans, <br />and specifications when ;~lalred by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15.34 11/91 <br /> <br />Date: '~\i:'~ I0 N (~{)L}N'I¥ <br /> BUILDING INSPE'C,I tUN <br />Issued by: <br /> <br />4. FEE SCHEDULE (Cor~plele and rmtvr total Jn A 1 bclow) <br /> <br /> Number of Inspections p~ permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service included: beths Co~t (each) <br /> 1000 aq, £~ or less $B5.00 .... 4 <br /> Each additional 500 aq. R. <br /> or purdon thereof $15,00 <br /> Limkcd Energy $20.00 1 <br /> Each Manof(I Home or Modular <br /> Dwelling Service or Feeder __ $40.00 __ <br /> <br />iL Servtee~ or Feeders (Do~s not inlcud¢ branch circuits, see section D) <br /> <br /> InStallation, Alterations or Relocation <br /> 200 aml~ or less <br /> 201 arnFs m 400 amps <br /> 401 amps to 600 amps <br /> (30lam to ~000 amps <br /> <br /> Reeotmect only <br /> <br />C. Temporary Services/Feeders <br /> Inst~llation, AB~'anon, or Relocation <br /> 200 re'rips or less <br /> 201 amps to 400 amp~ <br /> 401 amps to 600 amps <br /> Over 600 amps or I000 volt~ <br /> <br />D. Branch Circuits <br /> New, Altsraflon~ Or Extension Per Panel <br /> <br /> a) Thc f~ for bran~ circuits with <br /> purchasa of ~e~io~..0r feeder fca <br /> <br /> b) Th~ fee for branch ~xcuta w~thout <br /> imrchasc o~.:~ervlce of feeder <br /> <br /> lust branch circuit <br /> Each additional branch circuit <br /> <br />E. Ml~ellaneous (Service or Feeder Not Included) <br /> Each pump or irrigation ckcla <br /> Each sign or outline lighting -- <br /> Signal ci~uit(s) or a llmitod enemy <br /> panc1, a~taratlon or e,xten sion <br /> <br />F. Each additional Inspection <br /> ov~c the anowabl6 in any of <br /> show, per ]hspection <br /> <br />G. Minor Installation Labels <br /> Pack ~ 10 labels @ $$,00 each <br /> (suid only to electrical contractors) <br /> <br />[[, Other <br /> (A:: requlr~d by BuiIdi~ig Offices0 <br /> <br /> 80.00 <br /> <br />$~oo.oo __ e <br />$130.00 -- ~ <br />$300.00 __ 2 <br />$40.00 __ 2 <br /> <br />$35,00 <br />$40,00 <br />$80,00 <br /> <br />SZ0O ~0. tP0 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> Al, Enter total of fces from Sec. ~t4 ' <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Rater 25% of line Al for Pb, n Rcvicw <br /> (Sec, $), if requireZ <br /> C. ]l~v~t~ga~onFee (if requlrad) <br /> <br /> <br />