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IFOR. OFFICE USE ONLY I <br /> Received by: <br /> Date: <br /> <br /> ELECTRICAL PERMITAPPLICATION ~[ <br /> . P/ease complete all Sections, 1 through 5 <br /> <br /> 1. LOCATION OFINBTALLATION lUlLDING <br /> <br /> P~ ~E NON-~S~LE ~ NON~AB~ ~ <br /> E~E ~ WO~ IS NOT ST~D ~ 180 DAYS OF ~C~ <br /> OR · WO~ IS SUS~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Electrical Ccatractor <br /> <br />Mail~g Address <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPM~T CENTER <br /> 285 Church St NE - Room 132 <br /> Salem, O~gon 97301 . <br /> ITE #: <br /> <br /> JUN S97 ,,-uate: <br /> Issued by: <br /> ,1ARION CO INTY <br /> I NSI <br /> <br />Pmps~y Owner { Pho~ <br /> <br />Contractors Board Reg. No. ] 3'ob No. <br />Signature of Supervi:dns R3ecttic~n <br />Supervisor's IAcease No. I Phone No. <br /> I <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Thc ~t~afion is ~pm~ I ~n w~ ~ n~ ~ed f~ s~, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service ff 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 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 />MC 15-34 8/94 <br /> <br />Permit No. <br /> <br /> Number of Inspections p~' permit allowed <br /> <br />A. <br /> Re~dentlal <br /> Per <br /> Unit <br /> Service Included: Items Cest (each) Suml <br /> 1000 sq. ft. or ~.$s $85,00 <br /> E,ch add~tioaa1500 sq. ft. <br /> or porfio, thereof $15.00 <br /> Limed Ene~' $20.00 __ <br /> l~:h Ma~tt'd Home or Madutar <br /> Dw~ll~%o SevAce or Feede~ $40.00 <br /> <br /> S. Servi¢~ or Feeders (Does not inlcvde branch circults, ~ee section D) <br /> Ins~alla#on, Aneraflons m- Rdoeaflon ~200 amps or less $50'00 <br /> 201 amps to 400 amps $80.00 <br /> 401 amps to 600 amps $100.00 <br /> ~01 amps to 1000 ~ps $130.00 <br /> Over 1000 amps or volts $800.00 <br /> Reconr~ct only $40.00 <br /> <br />$35.00 2 <br />$40.00 2 <br />$,8O.00 2 <br /> <br /> $2.00 <br /> <br />$4o.oo <br />$40.00 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 ~ps to 600 amps <br /> Over 600 amps or 1000 volts <br /> S~ "e" above <br /> <br />D. Branch Circuits <br /> ~ew, Alte~stioa, or Exteasion Per Panel <br /> <br /> a) The f~e ~or brauch c~rcuiu <br /> porch~se of se~i~e ot feeder fcc <br /> <br /> Each branch circuit <br /> <br /> b) Th, f~ for b~meh cireut~ without <br /> nnml~e of se2viee or f~d~r fee <br /> <br /> Fire br~nch circuit <br /> Each additioaal branch cir~t <br /> <br />R. Miscellaneous (Service or Feeder No{ ll~cluded) <br /> ~ pump ~' i~igafi~ circle I <br /> E~ch sig~ or outlin~ ligh~g <br /> Signal circuit(s) or a limited energy <br /> panel, alteration ~: extension <br /> <br /> over ~g allowable in any of the <br /> <br />G. Minor Iast~ll~tiofl <br /> P~ck ~ 10 labeh @ $5.00 <br /> (sold oMy to electrical contractors) <br /> <br />ILOth~ <br /> (As required by Building Official) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotel <br /> <br /> B. Emer 25% of line At for Plan Raview <br /> (Sec. 3), if mqufled <br /> C. Investisati(m Fee (if required) <br /> D. Relmpectica Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br /> <br />