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· OR. ~FFICE USE ONLY [ MARION COUNTY BUILDING INSPECTION <br /> <br />Received by: [ 220 High Street NE <br />Date: ' Sslem, Oregon 97301 <br /> <br /> I c.,,, s,. , s / ,'- <br /> <br />Descriptie~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND [ <br />BXPIRB ]~ WORK I$ NOT STARTED W1TH]N 180 DAYS OF ISSUANCE <br />OR IF WORK T~ SUSPENDED FOR 180 DAYS. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />~nili~g Address <br /> <br />City/s~te./Zip <br /> <br />The instdla~en is being made co prepe~y I own which is mx intended for s~ <br /> <br />Owfle?s Si~mtur~ <br /> <br />3. PLAN REVIEW SECFION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of phns and spectficniions with <br />this applicntion. <br /> <br />This optional plan review program does not suspend thc <br />required submission of lighting powe~ calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br /> InelMla~on~ Alte~aflons or Rdoealion <br /> 200 amps or kss $~0.00 2 <br /> 201 amps to 400 amps $60.00 -- 2 <br /> 401 traps to 600 traps $100.00 __ 2 <br /> 601 amps to 1000 amps $130.00 -- 2 <br /> ~ 1000amps orvolts $300.00 -- 2 <br /> Remanect ~mly $40.00 -- 2 <br /> <br /> C. Temporm7 S~vlees/Feede~s <br /> Xnelallalion~ AIt~atlon~ o~ Rdoeaflon <br /> 200 amps or less $35.00 -- 2 <br /> 20! amps to 400 amps <br /> 401 maps to 600 maps ~:0~00 <br /> --2 <br /> Over 600 amps or 10C0 volts <br /> <br /> D. Branch Circuits <br /> New. Altm'atton. or Extension P~- Panel <br /> <br /> a) The fee fe~ branch c~cults wlth <br /> nmchase of set,ice ~ feeder fee <br /> <br />"'~b) T~e fe~ fo; I~anch drcuts <br /> ~mchue of sew~e o~ feeds- fee <br /> <br /> H~t branch ci~nit $35.00 <br /> Each addidoeat branch drc~t $2.00 <br /> <br /> E. Mbeellaneous (~e~vlce or Feedor Not l~eloded) <br /> Each pomp or i~igafion c~cle $40.00 -- 2 <br /> <br /> Signal elrcait(0 ~ a limited enc-~/ <br /> <br /> F. Eadl additional Ins~ctlo~ <br /> ovcr d~e allowable in any of ~e <br /> ~ pe~ ~nspe~ $..~.00 <br /> <br /> ~, ~lnor lnelnllatlon Labels <br /> (~old only to ~l~ctrical cor, tractor~) <br /> <br /> H. Other <br /> ~ A~ required by B~ldlng Official) <br /> <br />$. FEES <br />Al. Emer to~lof fins from Sec~ #4 $ ~._.~.~ <br /> A2, AddS%surcharge(.0SxA1) $ _-~ /~ <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if ~equimd $ <br /> C. Inv~d~ion Fee (if ~v,d) $ <br /> D. Reinspec~c~ Fee ($2~.00) $ <br /> TOTAL AMOUNT DUE $ ~ <br /> Receip~ No. <br /> <br /> <br />