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VOR OmC tJS ONLY <br /> Received by:. <br /> Date; <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> ¢:od~-A.Pho~: 5ss.79o4 SITE #: <br /> <br />FAX: $88-7948 <br /> <br /> ELECTRICAL PERMITAPPLICATION .... <br />........ P,,!~as,e complete all Sections, 1 through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />City <br /> <br />PERMITS ARE NON-TRANSFIiRABLI~ AND NON.REFLrNDABI !~ AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF 1SSUANCI[ <br />OR IF WORK 15 SUSPENDED FOR 1 S0 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Comractofs Board Reg. No,- ~ /ob No <br /> qs,,9 ? l <br /> <br />2B. FOR O~ER IN~ALLATIONS <br /> <br />P~ay Owner <br /> <br />Mltiling Address Phone <br />CityfStatedZ/.p <br /> <br />The installation is bein$ made on pfope~y I Own wMCll iS nO{ int~ded for sale, <br /> <br />Ownc?s Signature ....... <br /> <br />3. PLAN REVIEW SEC~rlON <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 the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Date: <br /> <br /> Issued by: <br /> <br />4, FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number {~ Inspections per permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) Sum <br /> <br /> 1000sqs. f~, m le~a $8§.00 <br /> Each ~lclifional fi00 ~q. h. <br /> or polrcicel t heff:oo f $ ~ $,00 <br /> Lir~ted l~gy $20.00 <br /> Each Manufd Home or Medulat <br /> Dwelling S¢r~/c¢ or Feeder $40.00 __ <br /> <br />B. Servlce~ or Feed~r~ (Do~ not inlcn~ branch circult~. *ce section D) <br /> Installation, Ait~-atlon$ or Relocation i' <br /> 200 amps or less f $50.00 <br /> 201 aml~ to 400 amps $60.00 __ <br /> 401 amps to 600 amps $100.00 <br /> 601 ampi to 1000 amps $130.00 __ <br /> Over 1000 aml~ or voks $300.00 <br /> Reconnect only $40.00 __ <br /> <br />C. Temporary Serviet,~t~F~eders <br />Installation, Ae~rstion, or Rdocatiou <br />~00 amps or l,ss $35,00 __ <br />201 mnps to 400 amps $40,00 <br /> 401am s to 600 am <br /> O~rx ~ amps or 1~ volts~ ,~,~ $80,00 -- <br /> <br />D, Branch Circuits <br /> New~ Alteration, or Exlet~slon Per Panel <br /> <br /> a) The re* for br~n~h dmuhs w~th <br /> ~urehas~ of service ot.~er fee <br /> <br /> I~ach branch cArmit $2.00 <br /> <br /> b)The fee for branch circuts ~t~out <br /> varchase of service or fee. der <br /> <br /> [:fi'st branch circuit <br /> Each addi~onal brandb c~mit $2.I)0 <br /> <br />E, Miscellaneous (Ear~lce er Feeder Nog Included) <br />Each pump or irrigation cirel~ $40.00 <br />Each ~ign or c~tlille _Ii, hUng $40.00 <br />Signal ¢imuit(s) or a lilIli~t ene. rgy <br /> $40.00 <br /> <br /> panel, alteration or ~xtension <br /> <br />F, ~ch additional Impectlon <br /> Over ~e ~owab~ ~ ~y of ~e <br /> <br />G. Minor l~mllation La~ls <br /> Pack ~ 10 lulls ~ ~.~ Ca~ <br /> (sold ody to electr~ol co~raclom) <br /> <br /> [As m¢~r~d by Build~ Officio <br /> <br />s. <br /> A 1, Enter total of fees from Sec. 04 <br /> A2, Add 5~ surehaeg¢ (,05 x A 1) <br /> <br /> Su~ml <br /> <br /> B. B~r ~% of ~c A1 for ~a~ R~view <br /> (S~. 3), if ~q~ <br /> C. ~v~atlonF¢¢ ~ mqai~) <br /> D. Reins~fim Fee ~.~) <br /> <br /> ~TAL AMOU~ DUE <br /> <br />$35.00 <br /> <br />$~,oo <br /> <br />$ ~ <br /> <br />Receipt No. <br /> <br /> <br />