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FOR OFFICE USE ONLY <br />Received-by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $$S-5147 8:00 mn - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Direc ' <br /> <br />PERMrrs ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITI II]q 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACFOR iNS~FALLATION ONLY <br /> <br />2E. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mailing Address Phone <br /> <br />City~tatefZip <br /> <br />The bmallafion is being mad~ c0a properly i own wMeh is not intended for sale, <br />lease, or rent. <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW 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 applicatioa, <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 />4. FEE SCHEDULE (Complete and enter loud m A 1 below) <br /> <br /> Number of Inspecaons per permit allowed <br /> <br />A. <br /> Residential <br /> P~r <br /> Unit <br /> Service Included: Items Cost (each) Sum <br /> $85,00 __ <br /> <br /> $15.00 <br />Each Manufd Home or Moduhr $20,00 <br /> <br />1000 sca, fi, or less <br />Each a~difiona1500 sq. ti, <br /> or po ~i,c~, ther~or <br />Limited Energy <br /> <br /> ! <br /> Dwelling Service or Feeder / $40.00 <br /> <br />B. Services or Feeders (Does not inlcude branch cireails, see se¢lion <br /> Installation, Alterations or Relocation <br /> 200 amps or less $50,00 <br /> 201 amp~ to 400 amps $80.00 <br /> 401 amp~ to 600 amps $~00.00 <br /> (~1 amps to 1000 amps $~S0.00 <br /> Over 1000 amps or volt~ SS00.00 <br /> Reconnect c~ly $40,00 <br /> <br />C, Temporary Services/Feeders <br />Installation, Alteration, or Reloeatinn <br />200 amp~ or l~s~ $35.00 <br />20! ~nps m 400 amp~ $40.00 <br />40! am ~ ~o 600 am <br />Over 6~ amp~ o~ 1~0 ¥olu <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Fanel <br /> <br /> a) The fee for branch c/mails with <br /> purchase or service or feeder fcc <br /> <br /> Each branch ¢~rcuk <br /> <br /> b) The ~ee fo~ branch <br /> purchase of service or feeder fee <br /> <br /> Fimt branch c/vuinl $~.00 <br /> Each additional branch c/mait SZ00 <br /> <br />l& Mlsce.aneous (Service or Feeder Not Included) <br /> Each pump or irrigation circle $40.00 <br /> Each ,q~gn or ou~oe Ughtigg -- $40,00 <br /> Signal c/reuit(~) or a limited enemy <br /> panel, alteration <br /> <br />F. Ea¢l~ additional Inspection <br />over the allowable in any of the <br />above, per Inspection $35.00 <br /> <br />G. Minor Installation Labels <br />Pack of 10 labels @ $5.0(I each $50,00 <br />{sold only to electrical contractor~) <br /> <br />lt. Other <br /> (As required by Building Official) <br /> <br />Al. Enter total of fees from Sec. #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of ime A 1 for Plan Review <br /> (Sec, 3). if mqaired <br />C, investiga/ionFee (ff required) <br />D, Reinsl~mfion Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />