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~"~'ved by: [Date: <br /> <br />MARION COUNTY BUILDING INSPECTION "~/ <br />COMMUNITY DEVELOPMENT CENTER <br />'- 285 Church St NE · Room 132 <br /> ~- PERMIT NO: <br /> -' - :/ Salem, OR 97301 Date: <br /> 2~1 hr. Inspection Line 373-4427 <br /> Office: Phom~ ~$g-~147 S:00am - 4:30pm <br /> FAX: 588-7948 ]~U(~ by: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all 8~tions, I througft <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> I <br />Cro~s $~Direcfiom: <br /> <br />Job Description: <br /> <br /> PI~IlTS AR~ NON-TRANSFI~RABI~ AND EX~'II~ IF W~ I$ N~ <br /> ~ ~ 1~ DAYS OF ISSU~ OR ~ <br /> WO~ 18 SU8~D~ FOR 1~ DAYS. <br /> <br />~ ~r P~ <br /> <br />Conu-actors Liceme No. <br /> <br />Contractor's Board Peg NO. ] lob No, <br />Signature of Sup~rviain~ Electrician <br />Su~rvisor's License No. I PhOne8 <br />2~. SOl~ owNaR InStALLATiONS <br /> <br />3. PLANRBVIBW SIICTION <br /> <br />Marion County does not require a plan review~ <br />We will provide plan review service if you complete <br />S~etion 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />4. ~'~ ~CH~DUI~ (Complete and enter total in Al below) <br /> Number of Inspections per permit allowed <br />A. Residential Pnr Unit ~ I <br /> Se~vie~Included: l~ms Cost(ea~h) Sum f [ <br />1000 sq. fi. or leas $85.00 4I <br />F.~h additional 500 ~¢4. ft. <br />or pot'tion ~hemof -- $15.00 <br />Limit~ya~,v/--.--.~, _ $2o.0o ~L. I <br />Eachl~anu factured H.~,~Modular <br />,~[llll~rFe~d~r I S40.0o .2L.Ma I <br /> <br />B. ~ a~ Feeders (Doea not in¢lud~ branch ¢ircuita, s~e section D) <br /> <br /> 200 amt~ or lc~ $50.00 2 <br /> 201 aml~ to 400 amps $60.00 2 <br /> 401 aml~ to 600 ampa $100.00 . 2 <br /> ~01 amps to 1000 amps $190.00 2 <br /> Over 1000 nmpa or vol~ $~00.00 2 <br /> Reconnect only $40.00 ._~_2 <br /> <br />C. Temporary ServleeMPeed~ra <br />Installation, Alt~atioa, oe Relocation <br />200 amps or le~ $35.00 2 <br />201 aml~ to 400 amps $40.00 2 <br />401 ampa to 600 am~ $80.00 2 <br />Over 600 amim or 10~0 volta <br /> <br />D, B~aneh Citmlits <br /> Nmv, Alterations, or lixte~sion Pec Panel <br /> a) The f~e for brach circuits <br /> <br /> Firm b~ch ~i~uit ~5.00 <br /> ~c.h ~ddition~l b~nch *k.~uit $ 2.00 <br /> <br />E. Miscellaneous (8~rvie~ ~ Feede~ Nm Included) <br /> Each pump or irrigation clrele <br /> Each sign or outllne lighting <br /> Signal circuit(s) ora limited cheesy <br /> <br />F. Eaefi additional Inspection <br /> Over the allowable in any of th~ <br /> <br /> (A~ required by B~ildiug O~itl) <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> ,W. fl. x $.068=__ <br />#ofLabeb NIC <br /> <br />5. FEES <br /> A 1. Enter total of feea flom Sec.//4 <br /> A2. Add 5% sttrcharg~ (.05 x Al) <br /> <br />Subtotal $ <br /> <br />B. Enter 25% of line A 1 loc Plan Review <br /> (Sec. 3), if required <br />C. Inveatigation Fe0 (if t~quired) <br />D. Reinspecfion Fee ($25.1{}0) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br />$ <br /> <br />MC 15-341/96 <br /> <br /> <br />