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FOR OFFICE USE ONLY <br />Received b~: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Omgon 97301 <br /> <br /> Phone 588-5147 8:00 am · 4:30pm <br /> Code-A-Phone: 5SS-7904 <br /> FAX: 58S-7948 SITE #: <br /> <br />ELECTRICALp/ease completePERMITall Sections,APPLICATION1 <br /> <br /> 1, LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND I <br />~],YPTR//LF WORK IS NOT STARTED WITkIIN 180 DAYS OF ISSUANCE <br />OR IF WORK I$ SUSPENDED FOR 180 DAYS, <br /> <br />Mailing Address Phone <br /> <br />City/St ate/~p <br /> <br />'lSe inaaBadon is being made orl property J~ own which is nra ~tended 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) ~ts 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 Skmctttral <br />Specialty Code, Chapter 53, <br /> <br /> PermitNo, <br /> <br />Date: <br /> <br />issued by: <br /> <br /> 4. FEE SCHEDULE (Compete a~lrl eater total in/~1 <br /> <br />~6TION Namber or insp<noas p~ permit allowed <br /> <br /> A. R~ld~nflal Per Unit <br /> Semite Included: ~tems Cost (each) Sum/ <br /> <br /> 10~ sq. ft. or less $85.00 <br /> Ea~ ad~tlo~ 5~ Sq, fk <br /> or ~m ~e~of $15,00 <br /> ~ ~e~y $20.00 <br /> E~h ManuFd Homo or M~uhr <br /> Dwe~ Se~ or F~d~ $40,00 .... <br /> <br /> ~ am~ or less ....... $50,00 ~ <br /> ~1 ~ps m 4~ ~ps $60,~ <br /> ~1 ~ to 6~ amps ~ $~00,00 <br /> <br /> ~ 1~ ~p$ or vdu $300,00 <br /> <br /> C. T~porary S~lce~dera <br /> <br /> ~ ~ps or ~$ $35,00 <br /> ~1 ~ps to ~ ~ps $40.00 _ <br /> 401 ~ps to ~0 am~paa $80.00 <br /> ~er ~0 ~ps &r 10~ volts <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 />$50,00 ~ <br /> <br />D. ]Branch Circuits <br /> New, Alteraflon~ or Extension Per Panel <br /> <br /> a) The fee for branch drcu~ts with <br /> pureha~ of,,scrvice ~ fe~er fee <br /> <br /> Each ~meh akcuit <br /> <br /> b) ~e fm for ~eh ~reut* ~ <br /> ~reha~* o[,s~ee or feeder,Ice <br /> <br /> F~t b~mh ~e~t <br /> ga~ addifi~ bra~ch drc~ <br /> <br />~, M~ellan~U$ ($ervl~ orF~der Not Included) <br /> Each ~mp ~ ~gafim circle <br /> <br /> Signal circuit(s) oc a hmie4 enemy <br /> <br /> a~ve, per ~specfion ~ <br />O. Minor ln~llation ~bels <br /> <br /> (~oM o~y to electrical contractors) <br /> <br />H. Oth~ <br /> ( ~ reqMred by Building Offlcla0 <br /> <br />$ J6.7Y <br /> <br />$ X <br /> <br />$ <br /> <br />$. gEES <br /> <br /> Al, Enter total o~ fees from See, #4 · <br /> AZ. Add 5% surehaI'ge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of line A 1 for I~lun Review <br /> (See, 3), if ~q~r~ <br /> C. ~vestigationFee (if mqoi~d) <br /> D. Re~sp~fim Fee ($~,00) <br /> <br /> TOTAL AMOU~P DUE <br /> <br />MC 1.%34 11/91 Receipt No. . <br /> <br /> <br />