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FDR OFFICE .USE ONLY <br />Received b,y:_ <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> MARION COUNTY BUILDING INSPECTi~ <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588.5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 SIT~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />JUN 0 <br /> <br />Date: ~[JJLI}ING INSPECTI0bJ <br />Issued by: <br /> <br />pFA~IITS ARE NON-TRANSFERABLB AND NO~-REFUNDAB L~ AND <br />EXPPRE IF WORK IS NOT STARTED WYI241N 150 DAYS OF ISSUANCE <br />OR IE WORK IS SUSPENDED FOR 150 DAYS, <br /> <br />2A, CONTRACII'OR INSTALLATION ONLY <br /> <br />Electrical Contrac · ' Phone <br /> <br />2g, FOR OWNER IN~AL~A'FIONS <br /> <br />proPerty Owner <br />Mailing Address Phone <br />City/State/Zip <br /> <br />The inatallauon is being made o~1 property I own wh/¢h is no~ intended for sale, <br /> <br />Owner'~ Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and stabmit two (2) sets of plans and specifications with <br />this application, <br /> <br />This optional plan review program do~ not suspend tho <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Cede, Chap[er 53. <br /> <br />MC 15.34 11191 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A 1 below) <br /> Number of Inspections per permit allowed -~ <br /> <br />A, <br /> Residential <br /> Unit <br /> I <br /> Ser~i~e Included: lt~s Co~t (~h) <br /> <br /> 1~ sq, fl, ~ Iaaa $85,00 ~ 4 <br /> Ea~ ad~fional 5~ sq. fC <br /> ~ ~ffi~ ~emof $15.00 <br /> L~ited Enemy $20,00 ~ 1 <br /> Each ManuC~ ~ome or M~alar <br /> Dwe~ng Se~ or Feeder $40.00 ~ 2 <br /> <br />B- $er~s or Fe~d~rs (Doe~ not inleude branch cimuits, ~ee section D) <br /> <br /> Insi~allaflon, Alterations or RelOcation <br /> 200 amps or lc'~s <br /> 201 aml~ to 400 ampa <br /> 401 amps to 600 amps <br /> 601 amps to 1000 amp~ <br /> O~r 1000 amps or volts <br /> Rec~neet cnqy <br /> <br />C, Temporary Services/Fe~ders <br /> Installation, Alteration, or Relocation <br /> 2~0 amps or less <br /> Z01 amps to 400 a~p~ <br /> 401 amps to 600 snaps <br /> Over 600 amps Or 1000 volts <br /> see "B" above <br /> <br />D. Branch Circuits <br /> New~ AIteration~ or Extension Per Panel <br /> <br /> a) Tho fee fo~ branch ~rcuits with <br /> purchase of nervSee o~ f~gd~r fee <br /> <br /> Each branch ctmuit <br /> <br /> b) Th* fee for I:rranch dreuts ~ <br /> porchase of service or feeder fee <br /> <br /> Fire branch elrcuit <br /> Each adclifional branch <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> ]~ach pump ar in/saQon circle <br /> Each ~ign or outline Iightittg . <br /> Sigaal circuit(s) or a limited energy <br /> panel, alteration or exleaasion <br /> <br />F. Each additional Inspection <br /> over the allowable ~a any of the <br /> above, per Inspection <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each <br /> (soM only to electrical contractors) <br /> <br />~, Other <br /> (As required by Building Official) <br /> <br /> · 50 O0 <br />"~o,oo <br /> $100,00 <br /> $130.00 <br /> $S00.00 <br /> $40.00 <br /> <br />$35.00 <br />$40.00 <br />$80.00 <br /> <br />$2,00 ~/-~ <br /> <br />$35.00 <br /> <br />$40.00 ~2 <br />$40.00 ~2 <br /> <br />$40.00 __2 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> Al. ~tet/cAul of fees froo~ Sec, #4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of [[ne A1 for Plan Rev{aw <br /> , (S~, 3),ifrequlr~ <br /> C, ~vesfigati~Fe¢ (~ ~q~md) <br /> D. Reinsp~l Fee ($~.~) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Rccci~ No, <br /> <br /> <br />