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I~.OR OFFICE USE ONLY <br />I Received by: <br /> ,Date: ' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 585-5147 8:00 am - 4:30pm <br /> Cod¢-A-Fdor~: <br /> IAX: 558-7948 <br /> <br />ELECTRtCAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />IZt,~ons <br /> <br />PF2LM1TS ARE NON-TRANSFERABLE AND NON-REFUNDABI~ AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 150 DAYS OF ISSUANCE <br />OR iF WORK IS SUSPBNDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />pfopsrty Owner <br />M~g Address { phone <br />Ci[y/State/Z/p <br /> <br />The lnstalh6on is being made on property t own which i~ not ~nt~nded for sal~, <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 />SITE#: <br /> <br />Date: <br /> <br />q 5- <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULI~ (Complete ~md enter total in A 1 below) <br /> <br />A, Re~idential Per Unit <br /> Se~lce Included: <br /> <br />$85.00 -- 4 <br /> <br />1000ms. ft or less <br />B~h ac'10ifional 500 sq. ft. <br />or peseta thereef $15.00 -- 1 <br />Limited Energy $20.00 <br />Each Ma~nf'd Home or Modular <br />Dwelling $¢rvi¢* or Fe~drx ~ $40.00 ~ <br />B. Services or Feeders (Docs not inloade branch cimalts, ace section D) <br /> <br /> Installation, Alteratlona or Relocation <br /> 50 O0 <br /> 200 amps or lcss $ ~C:¢0]00 <br /> 201 maps to 400 ~raps <br /> 401 amps to 600 amps $100.00 2 <br /> (fll amps to 1000 amps $130,00 2 <br /> Over 1000 amps or volts $300,00 2 <br /> Reeotmect only $40,00 __ 2 <br /> <br /> 200 amps or lcss $35,00 __ 2 <br /> 201 amps to 400 amps $40,00 -- 2 <br /> 401 amps to 600 ~mps $80.00 -- 2 <br /> Over 600 amps or 1000 volts <br /> <br />a) The fee for brench circuits ~ <br /> <br /> Each branch circuit $2.00 <br />b) The fee for brach circat~ without <br /> <br /> Each sign or outline lighting $40.00 ...... <br /> S~gnal circuit(s) or a limimd energy <br /> <br /> above, per Iusp*ction ~ $35,00 <br /> Pack of 10 labels @ $5,00 each $50.00 ..... <br /> <br /> ( A~ rtquir~d by Baildlng OfficiaO <br /> <br />5. FEES <br /> A 1, Enter tota/of fees f~tn Sec. #4 <br /> A2. Add 5% mmhatge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of'line A1 for Plan Review <br /> (S~0, 3), if required <br /> C, hivestigationF~e' (ff t~quired) <br /> D, Relnspectlon Fee (825.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> R~iF ~o, <br /> <br /> <br />