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FOR OlffFICE 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 588~5147 $:00 ~n - 4:30pm <br /> Code-A-Phone: 388-7904 <br /> v^×: 5~s.794s SITE #: <br /> <br />Lp ' ELECTRICALPERMITAPPLICATION "i <br /> lease complete all Sections, I through 5 <br /> <br />Date; <br /> <br />Issued by: <br /> <br />PermitNo, <br /> <br /> LOCATION OF iNSTALLATION <br /> <br />p~S ARE NON-~S~BLg ~D NON-~AB~ ~ : <br />B~E ~ WOrK IS NOT STARTED ~ l~ DAYS OF ~SU~C~ <br />OR ~ WO~ IS SUSP~ FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor ~d ~ 0 Phone <br /> <br />Propcr~y Owner <br /> z/ -/de.-' ' " <br /> <br /> FOR OWNER INSTALLATIONS <br />Property Owner <br /> <br />Mailing Address <br />Cjty/$tatefZip <br /> <br />The inst~tEaaon is l:~-I g mad~ on proge:~ I own wl-dch is n~x intended for aalc, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete SoCfion <br />5B and submit two (2) sets of plans and spec/fications 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 Stxuctaral <br />Specialty Cede, Chapter 53. <br /> <br /> 4, FEE SCHEDULE (Complete ~,¢I enter total in Al below) <br /> <br /> Number of Inspections per permit allowed <br /> <br /> A. <br /> R~identlal <br /> Per <br /> UnR <br /> Service Included: It~ Cost (ea~) Sam/ <br /> I0~ sq, R. ~ ~ss $85,00 ~ 4 <br /> Each ad~Q~l 5~ sq, <br />- or M~ tbe~f $15,00 <br /> <br />~ E<h Maned ~e or M~ular <br />~ Dw~ Sc~ ~ Fecd~ $40,00 -- <br /> <br /> B. $er~s or Feeders ~ocs not ~lcude branch cimu~ts, see section D) <br /> lns~llatlon, Alterations or <br /> <br /> 201 am~ w 4~ ~ps $~0.00 <br /> ~I ~ps ~ 6~ ~ps $~00.00 <br /> <br /> Re~ect ~ ~ $40,00 ~ 2 <br /> <br />C. Temporary ServlcedF~ders <br /> lnstallatinn~ Alteration, or Relocation <br /> 200 amps ot]~ss <br /> 201 amps to 400 amps <br /> 401 araps to 600 amps <br /> Over 600 ~trnps or 1000 volta <br /> <br />D. Branch CircuiLq <br /> <br /> a) The ~e* for branch e~fealts ~ <br /> <br /> Each addMonal branch c~reuit <br /> <br /> Each sign or ouflin~ ~.ghting <br /> Signal ~Lrcolt(s) or a IimiI~d enel,gy <br /> <br /> park of 10 labels @ $~.00 each <br /> <br /> ( A,~ required by Building Official) <br /> <br />$35,00 <br />$40O0 <br />$80.00 <br /> <br />$200 <br /> <br />$35,00 __ <br />$2.00 <br /> <br />$40,00 <br />$40.00 <br /> <br />$40,00 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> Al. Enter trial of fees from ,Sec, #4 <br /> A2, Add 5% su~chazgn 605 x A l ) <br /> <br /> B- Emir ~5% of line A1 for Plan Review <br /> (Sec. 3), if required <br /> C, InvestigationFce (ffrcquired) <br /> D. Reinspechc~ Fee ($25X)0) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MC ]5-34 11/91 Receipt No, <br /> <br /> <br />