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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-l~n~: 588-7904 <br /> F~: sss-7~4s SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ali Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />pERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABL~ AND <br />E,X?IRE I~ WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />property Owner <br />Mailing Address Phone <br /> <br />City/State/Zip <br /> <br />The installation is being mad~ on property I own which is not intended for sale, <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if 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 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />A. Residential Per Unit <br /> Service Included: <br /> <br />1000 sq. ft. orless $85.OO -- 4 <br />Each additional 500 sq. ft. <br />or portion thereof $15.00 <br />LimJled Energy $20.00 1 <br />Each Manufd Home or Modular <br />Dwelling Servine or Feeder $40.00 -- 2 <br /> <br />B. Services or Feeders (Does not inlcude branch circtfits, see section D) <br /> <br /> Installation, Alterations or Relocation., <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 s~aps to 60O amps <br /> 601 amps to 1000 amps <br /> Over 10~0 amps or volts <br /> Reconnect only <br /> <br />C. Temporary Services/Feeders <br /> Installation, AIt~ration, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 atnps or 1000 volts <br /> see "B" above <br /> <br />D. Branch Circuits <br /> New, AIta'ation, or Extension Per Panel <br /> <br /> a) The fee for branch circaits with <br /> purchase of sepdce or feeder fee <br /> Each brva3ch circuit [ ~- <br /> b) The fee for branch circuts without <br /> ourchase of service or feeder fee <br /> <br /> First branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pamp or irrigation circle <br /> Each sign or outline Eghting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension <br /> <br />E Each additional Inspeclio~ <br /> over the aliowable in any of the <br /> above, per ~nspecfion <br /> <br />G. Minor Installation Labels <br /> Pack of t0 labels @ $5.00 each <br /> (sold only to electrical contractors) <br /> <br />H. Other <br /> ( As r~quired by Building Official) <br /> <br /> ~so.oo 5-0' 2 <br /> 60.00 2 <br />$100.00 2 <br />$130.00 2 <br />$300.00 -- 2 <br />$40.00 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$2.0O ~ <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 -- 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> A l. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of llne A1 for Plan Review <br /> (Sec. 3). if required <br /> C. Investigation Fee (ff required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br />$ '74' <br /> <br />$ <br /> <br />$. 7-7.wo <br /> <br /> <br />