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FOR CITY VALIDATION] <br />Rets/red by:, <br />Date; <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITy DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Sa/em, OR 97301 <br /> <br />24 Hr lnsp~ion Line: 588-7904 <br />Offic~ 588-5147 8:00a.m.-4:30pan. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERMITS ARI~ NON-TRANSP'EKABLE AND E, XPI RIg IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 150 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />211. FOR OWI~R INSTALLATIONS <br /> <br />Property Owner (please pr/nO <br /> <br />3. PLANRI~VIEW SI~CTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Secdon 5B and submit two (2) sets of plans and <br />specificatillns with this-application. <br /> <br />MC 15-34 12./94 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FIlE SCHI~DI. rLI~ (~ognplct~ and enter total in A I below) <br /> <br />A. R~id~ntlal Pm' Unit Nmnb~r of~speetions p~ ~it ~Sowed~ <br /> <br />~ Include: Itc~ Co~t (each) Sm <br />1~ sq. fl, or less $85.~ 4 <br /> <br /> or ~aion ~em*' $15,~ <br /> <br />~& Manufaomred H~ or Modular <br />Dwelling Se~i~ et Feeder $40.~ 2 <br /> <br />B. 8~vie~ ~ F~$ (~s riel include branch ¢iguRg s~¢ sg¢tion D) <br /> <br /> Installation. ~Jt~ation or Reloeatio# __ <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> <br /> 601 amps to 1000 amps <br /> O~er 1000 amps or volts <br /> <br />C. Tempm-ary ServlcedFeedets <br /> <br /> 200 amps or less <br /> <br /> Over 600 amps or 1000 volts <br /> <br />D. EtaRcb Citeuita <br /> <br /> a) The fee for branch ¢/Icult~ ~ <br /> gurc, h~Loj service of feexler fee <br /> Each branch t:ircuit <br /> <br /> Signal oimuit0) or a timlgd ene2gy <br /> <br />ltl, Othe~ <br /> (As reqnircd by B~ildir~ Ol~clal) <br /> <br />$.50.00 2 <br />$60.00 2 <br />$100.00 2 <br />$130,00 2 <br />,$300.00 -- 2 <br />$4o.oo , 2 <br /> <br />$35.00 2 <br />$80.00 ...... 2 <br /> <br />$ 2.00 <br /> <br />$35.00 <br />$ 2.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 -- 2 <br /> <br />$35-00 <br /> <br />$50.00 <br /> <br /> ,,, ~t.g.x$.0~ =__ <br /># of Labels N/C <br /> <br />FEES <br /> Al, Enter total of fees from Sea, #4 <br /> A2. Add 555 surcharge (-05 x Al) <br /> Subtotal <br /> <br />B. ltnter25% of lineAl forPlanRevicw <br /> (See, 3)~ if ~qui~d <br />¢, Investigation Fee (if required) <br />D, R~impeetion F¢¢ ($25,~) <br /> <br /> ~T~ ~o~ DUE <br /> Receipt No, ,,, <br /> <br /> <br />