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FOR OFFICE USE ONLY <br />Received by: <br />Date: ' <br /> <br />"ELECTRICAL PERMITAPPLICATION ] <br /> Please complete all Sections, I through 5 <br /> I <br /> <br />MARION COUNTY BUILDING INSPECTI~., <br /> 'Salem, Oregon 97301 ~ ~ [:~_7 <br /> Phone$88-~14?S:OO~"n-4:30pmcod,_,_Pholm: ~SS-7904 Og~ 1 ~e~o, <br /> FAX: 5gS-?gaS SITE #; <br /> <br /> Date: ~,qP, ION P~j~.!'~'¥ <br /> BUILDING ~NSPECIION <br /> Issued by: <br /> <br />I. LOCATION OFINSTALLATION <br /> <br /> EXFIRE IF WORK IS NOT STARTED WrTHIN 180 DAYS OF ISSUANCE <br /> gA, CONTRACTOR INSTALLATION ONLY <br /> <br />'"~"rop~rLyOwner~ --~.. --.*~-/ } IPho~c,' <br /> <br /> Contractor'a Board Reg. No. ~.~r.~ 7 I Job No. <br /> Signature of Sulx:rvisklg Electrician J~--~--~6~/~- <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Propurty Owner <br />Mailing Address Phone <br /> <br />City/S[ateF~ip <br /> <br />The Installation is t~,ing ma4~ on propurty I own which is nc~ intended for ~alc, <br /> <br />Owners Signature ................ <br /> <br />3. PLAN RE¥[I~W SECTION <br /> <br />We will provide plan review service if you complete Section <br />513 a~d submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />reqeired sabmission of lighting power calcalation$, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />4. FEE SCHEDLFLE (Complete and ~nt~r total in A1 below) <br /> <br /> Numlmr of Inspections per permit <br /> <br />A. <br /> Residential <br /> Per <br /> Unti <br /> <br /> 10(iO sq ,fLor]ess $85,00 <br /> Each additional 500 sq, <br /> or iN,ion the~of $15.00 <br /> Limi~d Energy $20.00 <br /> Each Manef'd Home or Modular <br /> Dwe~log Service or Feeder $40.00 <br /> <br /> 200 aml~ or less <br /> 201 amps to 400 amps $60.00 <br /> 401 amps to 600 m'ap~ $100.00 <br /> 601 amps to 1000 am~ $130.00 <br /> Over 1000 amps or voBs $300,00 <br /> Reconnect ottly $40,00 <br /> <br /> C. Teroporary Servlcc,s/Feeaers <br /> InstallaUon, Alteration, or Relocation <br /> 200 ~mp~ or]ess $35,00 <br /> 201 ~nps ~o 400 am~ $40.00 <br /> 401 a~J>* to 600 amps <br /> Over 000 amps or 1000 volts <br /> <br /> a) Th~ f~e for branch clrca/t~ with <br /> <br /> Each branch cimui[ $2.00 <br /> <br /> b) The f~e for branch drcut* wlthont <br /> ~trchase of *erv/ce et feedel;~..qe <br /> <br /> First brand~ drcui~ $05.00 <br /> Each ad4itinnal branch circu/t $2,00 <br /> <br /> E. Mlscelhncou$ (Service or Feeder Not Included) <br /> gach pump or irdsat/on Circle __ $40,00 <br /> ~ch sign or outline l~hdng -- $40.00 <br /> Signal. drcait(s) or a limited energy <br /> l~nel, alteration or ~xte~d, oa $40,00 <br /> <br /> over the allowable/n any of th~ <br /> abow, per Inspection $35,00 <br /> <br /> Pack of 10 labets @ $5.00 each $50,00 <br /> (*old o~ly to *t~ctrical comraclors) <br /> H. Other <br /> ( As r~q~irdel by B~iIding Official) <br /> <br />Al. Enter total of fees from Sec. #4 <br />A2. Add 5% sumharge (.05 x A l) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec, 3). if requlrcd <br />C, brv~gat, ionFee (ff fequke4) <br />D, Rein~l:~..ct/on Fee ~25,00) <br /> <br /> TOTAL AMOUNT DUg <br /> <br />$ <br /> <br />MC 13-34 11/91 Receipt No, <br /> <br /> <br />