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~ MARION COUNTY BUILDING INSPECTIO~I <br />FOR OFFICE USE ONLY <br />Received b · 220 High S~t NE /~ <br />Da[~.v~ oy:~ Salem, ~g~ 97301 /ltl <br /> C~e-A-~e: 588-7~ ~ ..... did <br /> ELECTRICALPERMITAPPLIcATIoN Date' -- ~RIO2 ....... <br /> Please complete all 8oction~ l thmugh 5 Issued ~?ILDINo <br /> ' ' ' ' ~u)lON <br /> <br />PERMIT'S ARE NON.TRANSFERABLE AND NON'-RJ~FUFZDAB L~ AND <br />EX?I2RE IF WORK lB NOT STARTED WI'~II2q lO0 DAY,S OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRA~FOR INSTALLATION ONLY <br /> <br />PrO~y Owner,~ ] ~ '~ 1" <br /> <br />2B. ~OE. OWNE,'K II, ISTALLKrloN$ <br /> <br />Mailiag Address Phone.: <br />City/State?Zip <br /> <br />The irlstallatlon is being made on prol~ny I own which is n~ intended for sale, <br /> <br />Owner's Signature <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 thc <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />4, FEE SCHEDULE (Complete mid eater total in ~, 1 below) <br /> <br /> Residential <br /> Per <br /> Unit <br /> 1 <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> $86.00 4 <br />lOOO sq, fi, o~ less <br />Each additional 500 sq, ft, <br /> <br />Each Mam~fd flume or Modular <br />Dwelling $ervio~ or Feeder $~,O,00 <br /> <br /> 201 amp~ to 400 amps <br /> 401 amps to 600 amps <br /> 60I am~pss to 1000 amp~ <br /> <br />C, Temporary Services/Feeders <br /> Installation) Alteration, or Relocation <br /> 200 amps or les~ .... <br /> 201 arnp~ to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 aalp$ or 1000 volLq <br /> <br />D. Branch Ci~euiLq <br /> <br /> a) The fee for branch cbcnits w/th <br /> purchase of 55~ 'Ce or feeder ~0_4 <br /> <br /> Each additional branch circuit <br /> <br /> (As required by Building Official) <br /> <br /> ~50.00 2 <br /> 60.00 2 <br />$100.00 --2 <br />$130.00 ~ 2 <br />$300.00 .... 2 <br />$40.00 ~ 2 <br /> <br />$40.00 2 <br />SS0,00 ~2 <br /> <br />$2.00 <br /> <br />$s5.0o <br /> <br />$40.00 __2 <br />$40.00 2 <br /> <br />$40,oo ~2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al, Enter total of fees from Sac, #4 <br /> A2. Add 5% surchalgc (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of llne A 1 for Plan Review <br /> (See, 3). if required <br /> C, InvcstlgationFee (if required) <br /> D. Reinspcction Fee ($25.00) <br /> <br /> TOTAL AMOU N'I' DUE <br /> <br />$__ <br /> <br />MC 15-34 11/91 Receipl No. <br /> <br /> <br />