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iFoR OFFICE USE ONLY <br />Received by: <br /> .Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Or*goo 97301 <br /> <br /> phone 588-5147 8:00 am - 4:30pm <br /> FAX: 588-7948 SITE #: ' <br /> I <br /> Date: .~. <br /> <br />L LOCATION OFINSTALLATION <br /> <br />Directions <br /> <br />PERMITS ARE NON-TRANSPERABLE AND NON.REI~JNDABLE AND .... ] <br />EXI~.B IF WORK IS NOT STARTED W~ 180 DAYS OF ISSUANCE <br /> I <br />OR IF WO~ IS SUSP~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Con[raetor% Ro,rd~,s. lNo. St ~J~ ,~ I,obNo. C~ t~~ <br /> <br />Pmparty Owner <br /> <br />Mafllng Address Phone <br />Cixy]SxateffAp <br /> <br />The inststlat~o~l is being made on proI~r~y I own which is not intended for sale. <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 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 />Specia/ty Code, Chapter 53, <br /> <br />~, FEE SCHEDULE (Complete and enter total in A1 b~vfv) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> R~identlal <br /> Per <br /> Unit <br /> Service Included: ~t ¢a~S Co~t (~ach) S~m/ <br /> <br /> 10ffi sq. ft, or less , , $85,00 <br /> Each a~onal ~ sq, R, <br /> ~ thc~of $15.00 <br /> <br /> ~aeh Mano~d }I~c or M~ular <br /> ~ Dw¢~ ~i~ or F~ $40,00 <br /> <br />B, Ser~ or Feeders (~es not hlcude ~anch circults, see seefon D) <br /> <br /> Ink'reliction, Alterations or Relocation <br /> 200 amps or Jess __ $50.00 <br /> 201 amps m 400 amps SBO.O0 <br /> 401 amp~ to 6130 amps $ <br /> 601 ampx to 1000 amps $130,00 <br /> Over 1000 snaps or volts <br /> Reconnect c¢~ly <br /> <br />C. Temporary ServleesJl~eeder$ <br /> Installation, Alteration, or R~location <br /> 200 amps or leas __ $35.00 <br /> 201 amps to 400 amps $40.00 <br /> 401 amps [o 600 amp~q $130.00 <br /> Over 600 ~rnpa or 1000 <br /> <br />D. Eraneh Cimolts <br /> New~ Alteration~ or Extension Per Pallel <br /> <br /> a) The fee for branch <br /> poreham of *eev/.o~ or feeder fee <br /> <br /> Each brmcb cimult $2.00 <br /> <br /> b) The fe-~ for branch elrcut$ WithOut <br /> I~Chase of service or fo~der fee <br /> <br /> 15r~t branch ciwuit <br /> Each additional branch cJrolit <br /> <br />E. Miscellaneous (Servlee or Feeder Not Ineludnd) <br />Each pump or irr[gafic~ circle Sd0.00 <br />Each sign or outl~e ligh[ing Sd0.00 <br />Signal eiroult(s) or a ~mil~d energy <br />panel, alteration <br /> <br />F. Each additional Insp~ction <br /> over the allowable in any of the <br /> above, per Inspection <br /> <br />G, Minor Installation Labels <br />Pack of I0 Iabel$ ~ $5,00 each $50,00 <br />(sOld only to <br /> <br />tL Other <br /> ( As mqulmd by B~#dio$ Officio/) <br /> <br />5. FEES <br /> Al. Enter total of fee$ from Sec. #4 <br /> A2. Add 5% ~urcbat'ge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> FI. E~ter 25% of llne A1 for Plan Review <br /> ($CC, 3), if required <br /> C, Investisatio~lFee (if mquired) <br /> D, Rcinspccticm Fee <br /> <br /> TO'IAI, AMOUNT DUE <br /> <br />MC 15.34 11/91 Receipt No. <br /> <br /> <br />