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Received by: ] <br />Date: [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />28.5 Church StNE· Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />l. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED V~THIN 180 DAYS OF iSSUANCI~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />ZA. CONTRACTOR IlqgT ALLATION OHLY <br /> <br />Electrical Contractor <br /> <br />Pro~ Owner <br /> <br />2B. FOR OWN'ER INSTALLATIONS <br /> <br />Property Owner (pleasopri~) <br /> <br />Mailing Address [ Phone <br /> [ <br /> <br />City/S~atefZip <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SBCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULI~ (Complete and enter total in Al below) <br /> Ntanber of lnspe~tlons pet permit allowed -~ <br /> R~idontial <br /> Per <br /> Unit <br />8ervie~ Included: Items Cost(each) Sum <br />1000 sq. ft. or te~s $$5.00 4 <br />Each additional 500 sq. it, <br /> or poalon Iher~o f $ tS.00 <br />Limited Energy $20.00 <br />Each Manufactured H~-ne or Modular <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />B. 8e~vlces ~' Feeders (Does nut include branch circuit~, see section D) <br /> <br /> 200 amps or leas $50.00 2 <br /> 20| amps to 400 amps $60.00 2 <br /> 401 amps to 600 amps $ lO0.00 2 <br /> 601 amps to 1000 amps $130.00 2 <br /> Over 1000 amps or volts $300.00 -- 2 <br /> Reconnect only $40.00 -- 2 <br /> <br /> 200 amps or less $35.00 -- 2 <br /> 201 amps to 400 amps $40.00 <br /> 401 amps to 600 amps Sg0.00 -- .~ <br /> Over 600 amps or i000 volts <br /> <br />D. Branch Circuits <br />a) The fee for branch circuits ~ <br />Each branch circuit $ 2.00 -- <br /> <br />$35.~ <br />$2.~__ <br /> <br />E. Miscellaneous (~'d~.e ~ Feed~ N~ [nalud~) <br /> ~ pump or iMgation cilia ~.~ ~ 2 <br /> <br />Signal circuit(s) or a l~ited en~y <br />~el, alterati~ or exte~i~ ~.~ 2 <br />F. ~ additional [~tion <br />~r the allowable in any of ~e <br />a~ve, ~r lmpection $25.~ <br /> <br /> Pack of 10 l~els ~ $5.~ ~oh $~.~ <br /> (~d only to e/~tdea l comforters) <br /> <br /> (~ ce~uimd by Baildi~ O~ciaO <br /> <br /> sq. fl. x $.068 =__ <br />g of Lahals_ <br /> <br />[ 5. FEES Al. Enter totslof fees from Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br />(Sec. 3), if required $.__ <br />C. lnv~tigation Fee (if required) $ ,. <br />D. Reimpe¢fion F~e ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE $ <br />Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />