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OFF, ICE ..... I MARION COUNTY BUILDING INSPECTION <br />I FOR USE ONLY <br />Received by: 220 High Street NE <br />I ,Da!.e.!.: Salem, oregon 97301 <br /> Phone 588-5147 8:00 ~wa - 4:30pm <br /> Code-A-Phon~: 588-7904 <br /> PAX: 588-794s SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATIC~ <br />Please complete all Sections, I through 5, <br /> i1,,i I I II ILl[ <br /> <br />L LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />BXI:'I~E IF WORK IS NOT STARTED WITHIN 180 DAYS OF I$SUANCE <br />OR I~ WORK IS SUSPEI~DED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />P~t~'-~ Owner L,3 ~,* tr~ao~¢~, <br />¢ontra~ea ti~-~se No.' --~ -- k ~ 'Z C.. <br /> <br />FOR OWNER IN$TALLATIONS <br />PtOlemy Owner <br />Marling Addr*$~ Phone <br /> <br /> ~st~fi~ is ~g ~adc on p~ny I own w~ch is n~ in~nded ~ ~alc, <br />O~c~ Signature <br /> <br />PLAN REVIEW SECTION <br /> <br /> We will p~vide plan ~view service if you ¢oraplete S~tion <br /> 5B and submit two (2) sets of plans and Sl:~;ilications with <br /> this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plani, <br />and specifications when required by the Oregon structt~al <br />Specialty Code. Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Compl~to and ~l~tcr total ~n A I below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A, <br /> R~idential <br /> Unit <br /> Service Included: It~n ~ Coat (each) Sum <br /> <br /> 1000ssa. ft. or less $85,00 -- <br />Each a~dilional 500 s~l, <br />cc Mc~ the~of $15.00 <br />Limi~.a~nengy SgO.00 <br />Euch Manufd Home or Modular <br />Dwalli~ S,rvi~ or F¢¢d~r Sd0.00 __ <br /> <br />~. S~rvl~s or Feeders (Does not inleude brknch eircuiu, see section <br /> Installation, Alterallons or Raloeation <br /> ~0.00 __ <br /> ~00 anap~ or leas ..... $ <br /> 201 amp* to 400 ampa <br /> 401 amps to 600 amps $100.00 <br /> 601 ampsm 1000 ami~ 5180.00 -- <br /> Ow~ 1000 amps or volts 5~00.00 <br /> Kea:onn~t only -- $40,00 <br /> <br /> C. TempOrary s~rvice~A~'~dera <br /> Installation, AlteraUon, or RaloeaUon <br /> 200 ampa or lead $85.00 __ <br /> 201 ~npa to ~00 ~m~ $40.00 <br /> 401 am s to 600 am __ $80~00 <br /> <br />D. B~anch Circuits <br /> New, Alteration, or Extenslen Per Panel <br /> <br /> a) Thc fee for branch drcults with <br /> pumhase of service or feeder fcc <br /> <br /> Each branch alrcuit $2.00 <br /> b) The fee for Ixanch &routs ~elthout <br /> <br /> First branch c~rc,,;~ I $3S.00 ~_C..~.O <br /> Each additlonal branch circuit ~ $2,00 <br /> <br /> E, Miscellaneous (Service or Feeder Not Included) <br /> Each tmmp or i~igafi~ clinic $40.00 <br /> Each ~ or outl/ne llghfing $40.00 __ <br /> , Signal ~ircuit(s) or a Umitad energy <br /> panel, site-ration or ext~sion ............ $40.00 __ <br /> <br />F. ][ach additional Inspection <br />ovec the allowable in ~my of the <br />above, p~ ~ctlon 585,00 <br /> <br /> G, Minor Iastallatinn Labels <br /> Pack of 10 lat~lz ~ $5.00 each __ $$0,00 <br /> (sold only to electrical contractor::) <br /> <br />H. Other <br /> (As r~qtdred by Building Official) <br /> <br />$. FEES <br /> Al. Eater total of fees from Sec. #4 <br /> Ail, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of llne Al for Plan Review <br /> (Sea, 3), if ~quircd <br /> C, l~veatJsatlon Fee (ff required) <br /> D, Relnspee~on F*~ ($25.00) <br /> <br /> 'fOTAL AMOUNT DUI~ <br /> <br />Re.c. eilx No. <br /> <br /> <br />