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[ Ou omc ON,, <br />[Received by:. <br />II)ate: <br /> <br />MARION COUNTY BUILDING INSPECTI_ON <br /> 220 High Slxect NE <br /> Salem, Oregon 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections. I through 5 <br /> <br />LOCATION OF INSTALLATION <br /> <br />Dimcti~s <br /> <br />PEtLMITS ARE NON.TRANSFERABLE AND NON.REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTIiD Wl'rltlN lg0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR lgO DAYS, <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />MailingAddm*a ~,O, ~OX ,~lq Lt.)il~n~iit~ <br /> <br />Contrac~ia ~¢~seNo. ~- Iq~ ~C~ <br /> <br />Phone 588-5147 8:00 ~ - 4:30pm <br />Code-A-Phmm: 588-7904 <br /> FAX: 588-7948 <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Mailing Add.ss Phone <br /> <br />City/State/Zip <br /> <br />'['h~ ~llataBa~0n is be~uig ma~ ~ propc~y I °Wn which is not I~t~dcd for sal~, <br /> <br /> Owns:es Signature .......... <br /> <br /> 3. PLAN REVIEW S FJZTION <br /> <br /> We will provide plan review service if you complete Section <br /> 51t 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 requffed by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />SITE #: ,llfe'rqt ~. ,~993 <br /> <br />Date: --- " , t. uuNly <br /> UUILDtNG IN.q/art.,,... <br />Issued by: .... ~n <br /> <br />4. FEE SCHEDULE (Complete ired enter total in A 1 below) <br /> Numar of Inspections per permit allowed ---] <br /> <br />A. <br /> ReMdentlal <br /> Per <br /> Unit <br /> / <br /> Service Ineludedt hems Cost (each) Sum/ <br /> 1000 s% fl, or l~ss $85.00 __ 4 <br /> E~h additional 500 sq. ft. <br /> or pordon thereof $15.00 <br /> ~a ~z~rgy I $2o.oo ~-- 1 <br /> E~Ch Mano~d Home or Modular <br /> Dwelling 8~rvi~ or Feeder $40,00 __ 2 <br /> <br /> Installation, Alterations or Rtloeatlon <br /> 50,00 <br /> 200 amps or less ~60.00 2 <br /> 201 amps to400 ttmps __ 2 <br /> 401 amps to 6(10 amps $100,00 __ 2 <br /> 601 amp~ lo 1000 aml~ $1:30.00 __ 2 <br /> Over 1000 amps or volts $300.00 <br /> Reconnect oMy $40.00 __ 2 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alteration or Retaeaaon <br />200 amps or l~ss $35.00 __ <br />201 amps to 400 amps $40,00 -- <br />401 ~yaps to 600 amps $00.00 <br />Over 600 amps or 10~0 vok~ <br /> <br />D. Branch Circuits <br /> New~ AIt~anon~ or Extensioll Per Panel <br /> <br /> a) Thc fee for branch d~ui~s with <br /> pum~le of sewlc~ or leader fcc <br /> <br /> Each branch circuit $2.00 <br /> <br /> b)The fee for branch ~rcuts without <br /> purchase of s~Iy~ee ot feeder <br /> <br /> First branch circui~ $$8,00 <br /> Each additional branch circuit $~.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each ixlmp or irtigati°~ circle $40,00 -- <br /> Each fign or outline lighting __ $40,00 2 <br /> Signal circuit(s) or a llmltod energy <br /> panel, alteration or extension $40.00 __ 2 <br /> <br />F. Each aflditlonal Inspection <br />over the allowable in any of th~ <br />above, per Inspection $:35.00 <br /> <br />G, Minor Installation Labets <br />Pack of 10 labels @ $$.00 each $50.00 <br />(~old only to ¢l¢ctric.l <br /> <br />H. Other <br /> ( A$ required by Buildi~$ OfficiaO <br /> <br />5. FEES <br /> Al, Fmter total of fees from Sec, #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enl*r 25% of line A 1 for Hah Review <br /> (S~. 3), if required <br /> C. Investigation Fee (ff ~qui~d) <br /> D. Reln~pection Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />,,, Receipt No, <br /> <br /> <br />