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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88-$147 8:00 ara - 4:30pm <br /> Code-A-]Phone: 588~7904 <br /> FAX: $$8-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />E~E ~ WORK IS NOT STA~D ~ 180 DAYS O~ ~$UANC~ <br />OR IP WORK I~ ~USP~ED FOR 180 DAYS, <br /> <br />2A- CONTRACTOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Prol~rty Owner <br /> <br />Mai~ng Addgss Phone <br /> <br />City/St at~FZip <br /> <br /> Oumc~'s Signature <br /> <br /> ......... I Il I I}l J Jl~l <br /> <br /> 3. PLAN RE¥IEW 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 thc <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 /> dhN 9 9 1995 <br /> ..... <br /> SITE #: ~Atitun ~'~'~ .... <br /> Date: <br /> <br /> Issued by: <br /> <br />4. ~ $C~[ (C~plem ~d ~m~ toal ~ A1 Mow) <br /> <br /> Numar <br /> <br /> R~denflal <br /> Unit <br /> ~e~le~ Inelud~ It--s C~t (~) ~um/ <br />1~ s . ~ ~ l~ss $8~,00 ,. 4 <br /> <br />~ ~y $20.00 <br />~h ~ufd ~ or M~u~r <br /> <br /> or <br /> <br /> ~ ~ w less <br /> <br /> ~1 arum ~ l~ps $~0,~ <br /> ~r 1~ ~p~ or vol~ $~0.~ <br /> <br />C, Temporary Services/Feeders <br />In~allatlon, Alteration, or <br />200 amps or l~ss $35,00 __ 2 <br />201 amps to 400 amps $40,00 <br />401 amps to 600 amps $80,00 __ 2 <br />Over 600 amps or 1000 volt~ <br /> <br />D, Branch Circuits <br /> <br /> a)Tbe f~ fm branch ~i~Ls with <br /> ~grgl~a~q~ Of ~ervice or feeder <br /> <br /> Each branch circuit <br /> <br /> b) Thc ft~ for branch cireuts wi~out <br /> rcha e of se '¢ <br /> <br /> Fire brach 6rcuit $35.00 <br /> Each addffic~al branch ~ircnit ~ $2.00 <br /> <br />lg. M~naneous (Servl~e or Fe~der Not In¢lude~) <br /> Each pump or inlgali~ ciml¢ $40.00 .... 2 <br /> Each sign or eqtlJ~e lighting __ $40.00 __ 2 <br /> ~ignal c~xctdt(s) or a limited eae~gy <br /> panel, alteration o~ e.xt ~a6,oa $40.00 <br /> <br />E ga~# additional Inspection <br />over thc allowabl~ in any of th~ <br />abow, pet Iaspextion $35.00 <br /> <br />G. Minor Installation Labels <br />Pack of 10 labela ~0 $5.00 each $50,00 <br />(sold only to electrical contractors) <br /> <br /> ( A~ required by Building Offf~ia0 <br /> <br />5. FEES <br /> Al. Ent~ total of fe~s from S~ #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> Fl. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br /> C. InvcstlgatinnFee (ff required) <br /> D. Rcinsl~tlon Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />