Laserfiche WebLink
FOR OFFIC..~USE ONLY I <br />Received b3{:~ I <br />Date: ] ~)!J? .~/~7 I <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Slreet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 5ss-7~ng SITE g: <br /> <br />Please complete all Sections, 1 through 5 I <br /> <br />Date: <br /> <br />Issued by: <br /> <br />1. LOCATION OF~INSTAL_L3_ .TION <br /> <br />Dir~ctic~s <br /> <br />PERMITS ARB NON-TRANSFERABLE AN*D NON-R~FUNDM~LE AND <br />EXPIRE IF WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Electtieal Contmc~r <br /> <br />Su> i,of, dcen,e No.,.-3 / J Tt:g, <br /> <br />20. FOR OWNER INSTALLATIONS <br />Property Owner <br />Mailing Address Phone <br /> <br />City/State/Zip <br /> <br />Owners Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />50 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 Sl~uctural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4. FEE SCIIEDULE (Complete and enter total in A 1 below) <br /> <br /> Number of Inspections pe~ permit allowed <br /> <br />A. <br /> Retidential <br /> Per <br /> Unit <br /> [ <br /> Servke Included: Items Co~t (each) Suml <br /> 10~0 sq. ~ or ~ss $85.00 4 <br /> Each additional 500 sq. ft. <br /> or portlon themof $15.00 -- <br /> Limited Energy $20.00 -- I <br /> Each Ma~ufd Home ar Mochflat <br /> Dwalling Service or Feeder $40.00 -- 2 <br /> <br />B. Services or Feeders (Does no~ inlcudc branch circuits, see section D) <br /> Installation, AlteraUons or Relocation / <br /> 200 amp~ or less $50.00 ~, <br /> 201 amps to 400 amps $60.00 -- 2 <br /> 401 amps to 600 amps $100.00 -- 2 <br /> ~Olam tol00Oamps $130.00 -- 2 <br /> Over 1}~)(~ ~mps or volt~ $~00.00 -- 2 <br /> Reconnect only $40.00 -- 2 <br /> <br /> C. Temporary Set/lees/Feeders <br /> Installation, Aneratioa, or Relocation <br /> 200 amps or less $35.00 -- 2 <br /> 201 amps to 400 amp~ $40.00 -- 2 <br /> 401 amps to 600 amps $80.00 2 <br /> Over 600 amps or 1000 volts <br /> see "B" above <br /> <br /> D. Branch Circuits <br /> New, Alteration, or Ext ensinn Per Panel <br /> <br /> a) Th~ fee fo~ branch circuits with <br /> ourchase of set'Ace or feeder fee <br /> <br /> ~ch b~ch cimuit ~ SZ0O <br /> <br /> b) The fee for branch cimms wifl3qut <br /> ourchase of sexvice or feeder fee <br /> <br /> First Blanch cileuit $35.00 <br /> Each addidonal branch circuit $2.00 <br /> <br /> E. Miscellaneous (Service or Feeder Not Included) <br /> F~ch pump or irrigation circle $40.00 2 <br /> Each sign or eutlJme lighting $40.00 -- 2 <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension $40.00 2 <br /> <br /> E Each additional Inspecfl~ <br /> over the allowable/n any of <br /> above, per Inspeetion $35.00 <br /> <br /> G. Minor Installatio~ Labels <br /> Pack of 10 labels @ $5.00 each $50.00 <br /> (gold only to electrical contractors) <br /> <br /> It. Other <br /> ( A~ r~quir~d by Bialding Official) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x A1 ) <br /> <br /> Subtotal <br /> <br /> B. Emer25%oflineA1 for Plan Review <br /> (Sec. 3), ff required <br /> C. Investigation Fee (if reqUa~d) <br /> D. Reinspectinn Fee ($25,00) <br /> TOTAL AMOUNT ~tt~ <br /> Re, ceipt No. ~ ~ <br /> <br />$ <br />$ <br /> <br /> <br />