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MARION COUNTY BUILDING INSPECTION <br />FOR OFFICE USE ONLY <br />Received by: 220 High Street NE <br /> Salem, Oregon 97301 <br />Date: <br /> Phone 588-5147 8:00 am - 4 '3 0gnn <br /> ce,. C~e-A-~one!58S-7~04 SITE #: Permit No~. <br /> ELECTRICAL PERMIT APPLICATION ~Jc~~-~"~Date: - -- <br /> P/ease complete al/Sections, I through litt''~ c3 '~1111. .. <br /> <br /> L LOCATIONOFINSTALLATIO, MARION CO[. ~j,~fFEESCHEDULE(Completeandent:rtotalinAlt~'.inw) <br /> :ohAdd,::: ~ -/~t/'/~77~/V' ff~,L/DING I ISP CTION <br /> <br />Dir~cdcas <br /> <br />Des~/ption <br /> <br />PERMITS ARE NONiTRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WOILK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />eA. CO .*CTOR STAL OZ , <br />ElectrkalCmumc~or HONEk~'ELL ' ~ne 968-3353 <br />M~gAdd~: 15495 SW Se~oia P~ay, Suite 100 <br /> P~rfl and . OR <br /> <br />~n~c[of~ ~ No. 26-207C~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Ptopsr~y Owner <br />M~iling Address Phone <br />City/~t ate/Zip <br /> <br />The installation is being made on property I own which is nc~ intended for sale, <br /> <br />Ownees Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />j. <br /> <br />We will provide plan review service if you ~omplete 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 the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> 1000 sq. ft. or less $85.00 <br /> Each additional 500 sq. f~ <br /> ~ gon~c~ thereof $15.00 <br /> [~n~t~d Energy $~0.00 __ <br /> Each Manufd Hem~ or Modular <br /> Dwdling Se~wice or Feeder $40.00 <br /> <br />B. Services or Feeders ('Does not/nlcude branch circuits, se~ seaion D) <br /> Installatinn~ Alterations or Relocation <br /> 200 amps or less $50.00 <br /> 201 amps to 400 amps $60.00 <br /> 401 amp~ to 600 amps $100.00 -- <br /> 601 amps to 1000 arnpe $~30.00 -- <br /> Owr 1000 amps or vohs $300.00 <br /> P, ~nnn¢ct o~ly $40.00 __ <br /> <br /> C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less $35.00 <br /> 201 amps to 400 amps $40.00 <br /> 401 a'nps to 600 amps $80.00 __ <br /> Over 600 amps or 1000 volts <br /> $~ ~B~ above <br /> <br /> D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) Tha fee for branch circuits wirh <br /> purchase of scrvic~ or feeder fee <br /> <br /> Each branch circuit $2.00 <br /> <br /> b) The fe~ for branch clrcuts without <br /> vurchas¢ of service or feeder fee <br /> <br /> Firzt branch circuit $35.00 <br /> Each additional branch circuit $2.00 <br /> <br /> E. Miscellaneous (Service or Feeder Not Included) <br /> Each pemp or irrigation circle $40.00 <br /> Each sign or oJtiine lighting $40.00 -- <br /> Signal circuit (s) or a limited energy <br /> psneI, aherafion or extemion I $40.00 <br /> <br /> F. Each additional Inspection <br /> over the allowable in any of the <br /> above, per Inspection $35.00 <br /> <br /> G. Minor Installation Labels <br /> Pack of 10 labels @ $5,00 ~ach $50.00 <br /> (sold only to electrical conlractor$) <br /> <br /> Iq. Other <br /> (As req~drzd by Building Official) <br /> <br />5. FEES <br /> Al. Enter t~xat ~f fer.~ from Se~ #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of lin~ A1 for Plan Ruview <br /> (Sec. 3), ff mq~r~d <br /> C. Inv~tigafion ~r.x: ('ff requital) <br /> D. Reinspecfion F~ (S25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />,$ <br /> $ <br /> $ <br /> <br /> <br />