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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> Phone 588-5147 8:{30 ~n - 4:30pm <br /> Code-A-Phca~: 588-7904 <br /> FAX: 588-7948 <br /> <br /> ELECTRICAL pERMIT APPLICATION <br /> Please complote all Sections, i through 5 I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St, NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> 7 <br />BUILDING iNSpEcTtO~~ <br /> <br />I. LOCATION OFINSTALLATION <br /> <br />pEP. MITSARENON-TI~ANSFERABLEANDNON-RI~FUi~DAI~I~AND' ' i <br /> <br />IgXialRE IF WORK IS NOT STARTED ~ 180 DAYS OF I~SUANCE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Property Owner ~ · ' ' Phone <br />Contractor'~ Licen sc No. <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Mailing Address Phone <br /> <br />City~tate/Zip <br /> <br />The installation is being made on p~peay I own which is nm intended ~or sale. <br /> <br />Owner's Signature ...... <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Wc will provide plan review service if you complete Section <br />58 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 />sad specifications when required by thc Oregon Structural <br />Specialty Code, Chapter 53, <br /> <br />MC 15-34 8/94 <br /> <br />4, F~E SCHEDULE (Complete and enl~r toal in A 1 below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Se~ice Included: It, s Cos~ (~ach) S~/ <br /> 10~ sq, ~ ~less $85.00 ~ <br /> <br /> or~m ~emof $15.00 <br /> ~d Enc ~ $20,00 ~ <br /> Each Manu~omc or M~uhr <br /> Dwc~ng Sc~m or Feeder <br /> <br />B. Ser~s or Feeders (Does not ~lcude branch circuits, acc section D) <br /> <br /> Installa0on~Alteratlons or Relocation <br /> 50.00 <br /> 200 amps or less $ ~60.00 <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps $100,00 <br /> 601am~psj s m 1000 amps $~ S0,00 <br /> Over 1000 amps or voits $~00.00 <br /> P,~connect mlly $40.00 <br /> <br />C. Temporary S~rvlcerdFt, eders <br />Installation, Altoraflon, or R~loeatinn <br />200 amps or less $~5.00 <br />201 amps to 400 amps $40.00 <br /> 401 am s ~o 600 am s $80.00 <br /> Over ~a(~ romps or I~?~0 volts <br /> <br />D. Branch ClrculB <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for bra~ch dreuhs with <br /> r, umhase of s~vlca or feeder fee <br /> <br /> Each branch circuit $7'.00 <br /> b) The fee for branch cimuts withont <br /> <br /> First branch ¢imuit $35.00 <br /> Each additional branch alrcuit SP.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irdga~oa efrci¢ $40.00 <br /> Each sign or ou~n, .~ghtlng -- $40.00 <br /> Signal circaE(s) or a ]gn~t~d energy <br /> Fanel. alteration or extqaasion SdO.O0 <br /> <br />E Each addltional Inspection <br />over the. allowable in any of thc <br />above, per inspection $35.00 <br /> <br />G. Minor lnstaltatinn Labels <br />Pack of 10 labels @ $$.00 each $50,00 <br />(sold otdy to elecirical contractors) <br />FI. Other <br />( As requdred by Building Official) <br /> <br />5. FEES <br /> Al. l~nter total of fees from Sec, #4 $ <br /> A2, Add 5% surcharge (.05 x Al) $ <br /> <br /> Subtotal $ <br /> <br /> B~ Enter 25% of linc A1 lbr l'lan Review <br /> (Sec, 3!, if required $ <br /> C, Investigation Fee (if requi~ed) $. <br /> D. Rcln~pcctioa Fee (525,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt ~I9. __ <br /> <br /> <br />