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FOR OFFICE USE ONLY <br />Received by: <br />Date:. <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Slze~t NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88-5147 8.'00 ~n - 4-.30pm <br /> Co,e-A-Fao. e: 588-7904 <br /> F~X: 5SS-794S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Plefise complete all Sections, I through 5 <br /> <br /> 1. LOCATION OFINSTALLATION <br /> <br /> b Add,~ss <br /> <br /> Cro~ Si. <br /> <br /> EXI~RE ~ WO~ ~ NOT ~ ~ 1~ DAYS OF <br /> OR ~ WO~ ~ SUSP~ FOR 180 DAYS. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No~ <br /> <br />2A. CONTRAC'fOR INSTALLATION ONLY <br />ElecuiC~Cc°u'acu~r HONEYWELL' IPhOne 968-3353~I· <br /> <br />Con~c, ot, Uc~,c No. 26-207CLE <br /> <br />Con~c~or%Bo~lRes. No. 57824 11°bN°' ~ ]/,~ <br /> <br />FOR O W~'ER INSTALLATIONS <br /> <br />Propsny Owner <br />Mailing Address Phone <br /> <br />City/~tate/Zip <br /> <br />"~e installsKon is b~ing made on p~p~ny I own wMch is ~cl inte. nded for <br /> <br />Owne?s Sigr~mm <br /> <br />3. PLAN REVIEW SECTION <br /> <br />, .. 'We will provide plan review service if you complete Section <br /> 5B and submit two (2) sea of plans and spccificauons w~th <br /> this application. <br /> <br />This opdonal plan review program does not suspend the <br />re4uired submission of lighdng power calculations, plans, <br />and specifications when required by the Or~gon Structural <br />Specialty Code, Chapter 53. <br /> <br />4. FEE SCHEDULE (Complete ~'~d en~r total in Al below) <br /> <br /> Number ~ In.-'pections per 'permit zllowed -"l <br /> <br />10(10 sq. f% ~' l~s $85.00 __ 4 <br />Each additional $00 sq. ~ <br />c~ po~icu thereof $15.00 <br />~ Enc~y $20.00 -- 1 <br />Each Manufd Hom~ or ,'Vied!tier <br />Dvc~lllns Sen, lc~ or F~d~ $40.00 2 <br /> <br />B. Services or Feeders 0)oe.s not ~lcude branch circ~z, se~ s~:~en D) <br /> Installatton~ Alterations or Relo~atlon <br /> 200 amps or l~s $50.00 2 <br /> 201 amps to 400 ~mps $60.00 2 <br /> 401 amps to 6C0 amps $100.00 2 <br /> 60t zmp~ to I(DO amps $130.00 __ 2 <br /> Over I000 ~ps or vol~ $300.00 __ 2 <br /> P, econacct culy $40.00 __ 2 <br /> <br /> C. T~mporar7 Services/Feeders <br /> Inst~llatlon, Altet'ation, or Re~oczQon <br /> 200 amps or lc~s $35.00 2 <br /> 201 ~ps m 400 amps $40.00 2 <br /> 401 amps to ~00 amps $80.00 2 <br /> Ov~ 600 amps or 10CO vol~ <br /> <br /> D. Brzuch Circuits <br /> New~Alt~aflon~ or .Extension Per P~nel <br /> <br /> a) 'I~e fcc fo~ branch <br /> <br /> Ea~ bra~ch circuit $2.00 <br /> <br /> b) "~e fee ~or brach ~aeu~s ',,~h out <br /> ~cbase of sea-ice or feeder tee <br /> <br /> · wz~t br~nch circuit $~.5.00 <br /> Esch additional bt-~nch circuit $2.00 <br /> <br /> E. Miscellaneous (Service or Feeder snot Included) <br /> Each ix~np or irrig~fien cixcl¢ $40.00 2 <br /> Each sign or o~tli=¢ lighting $40.00 -- 2 <br /> Signa! circuit(s) or a limited enexgy <br /> / <br /> panel, alteration or extension ~' $40.00 <br /> <br /> F. Each additional In~ectio~ <br /> over Ihe allowahl~ in any of thc <br /> above,, per Inspection $35.00 <br /> <br /> G. Minor Installation Labels <br /> Pack of 10 labels @ S5.00 ~ach $50.00 <br /> (sold only to electrical con~ractors) <br /> <br /> H. Other <br /> ( A~ required b7 Bulid~ O~-tc~al) <br /> <br />5. FEES <br /> AL Enter total of fees from Sec. #4 <br /> A2. Add 5% s~mchn~e 605 x Al) <br /> <br /> Subtotal <br /> <br /> B. ~r ~% of~ Renew <br /> (S~ 3), <br /> <br /> D. Re~ <br /> <br /> TOT~ ~O~ DUE <br /> <br />,$. <br /> <br />$ <br /> <br /> <br />