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FOR V m^UON <br />Received by:. <br />Date: , <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br /> 14 hr. In~Pecfi°n Li~e 375.4427 <br />Office: Phone 58g-5147 8:00am - 4:30pm <br />FAX: ~8-7948 <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~octions, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />hddr~s <br />Phon~ Fax// <br />Properly Owner ~ Pho'n~g <br />Contractors Liccr~e No. <br /> <br />Contractor's Board R~g No. <br /> <br />$igramre of Supervising Electrician <br /> <br />.lob No. <br /> <br />Supervisor's License No. t Pho~ <br /> <br />3. PLAN RE¥.taW' 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 subn~it two (2) sets of plans and <br />specifications wi~ this application. <br /> <br />MC I5-341196 <br /> <br /> 4. FI]R SC]~tD~[.~ (Complete and entee total in Al b~low) <br /> R~id~mial P~ Ualt Number o f Inspections p~ permit allowed ---~ <br />A. <br /> 8e~tie~ Inclnd~l: Itewa Coat (~aeh) S <br /> 1000 gl- t~ or I~ $85.00 4 <br /> · Each additional 500 gl. ~ <br /> or portion ~a'eo f $ I $.00 <br /> L/mit~ Encrgy $20.0O <br /> Each Manufactured Home or Modul~ <br /> D we, llLng ,~tice o~ Feeder $40.00 2 <br /> <br /> B. $~-vieea ~F~de~a~Does not include branch ¢ireui~ ae~ acc/ion D) ~ <br /> Installalio~ttl~t~ o~ Reloeation j I" ~ <br /> 200 am~ or le~ I $50.00 ~ 2 <br /> 201 ~mps to 400 amgs $60.00 . ,2 <br />i 401 amps ~o 600 amOa $100.0O __2 <br />601 amps lo 1000 amps $130.00 -- 2 <br /> Owr 10O0 amps or rolls $300.00 2 <br /> Rewnnect only ,~O.00 -- 2 <br /> <br />C. <br /> last~lhtlon, Alteration, or Reloeatlon <br /> 200 am[~ o~ l~a $35.00 __2 <br /> 201 amps to 400 am~ $40.00' __2 <br /> 401 amps to600 amoa $8&00 __2 <br /> <br /> ID. Branch Ckcalta <br /> <br /> a) The fee rot brach circuit~ with ~} 0 <br /> - <br /> Each tnauch ch, cult $ 2.~0(~__ <br /> <br /> Each additional brauch circuit $ 2.00 . <br /> <br />$40.00 . ,2 <br />$40.0O ~ 2 <br /> <br />$35.0O -- <br /> <br />$50.00 <br /> <br /> sq. fi. x $.068 =__ <br /># 6fLat~la N/C <br /> <br />FEES <br />Al. Enter Iotal of fe~ from See. fi4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. EaSt25% oflinaAl fo~PlanRcviow <br /> (~. 3), if requlr~d <br />C. lnvestigallo~ Fee {i f ~q ulred) <br />D. Reinsgeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt Ho. <br /> <br /> <br />