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ELECTRICAL PERMIT APPLICATION <br />Please complete all Secltons, I through $ <br /> <br />~OCATION OF INSTALLATION <br /> <br />si~Ad~ss: ,'~?Y'J.O oc~re~ <br /> <br />Mailing Add.ss <br />City: Sate: Zip; <br /> <br />Co~trac~ Lic~q~ No: <br /> <br />S u I:~".'iso* L I~rise NO: <br /> <br />!ignamm of Sal~'rvisin8 Electrician: <br />~R O~gR mST~TION <br /> <br />ci~r: ~t~ sm~: 0 g zip: ~7o~ ~ <br /> <br />I am t~e PROPER~ O~ER and own, re~ige ~. or wgl reside in the <br />completed s~uc~re a~ will 6e my own general con,actor. I <br />understand that I mu$t reenter a$a ao~uction con,actor ~ the <br />s~crur e i$ sold or offered for sale before or u~n co~letion, lft <br /> <br />Con~actor~ B~rd. I will i~mediate~ not~ Marion Coun~ of the <br /> <br />3., P~ RENEW SE~ION <br /> <br /> M~ C~n~ d~ n~ ~ukc a ~ ~i~. We ~11 ~vi~ <br /> ~an ~i~ ~i~ if you ~ ~ 5B ~ ~l ~ (2) <br /> ~ afpl~ and ~i~ti~ ~ ~is a~l~ti~. , <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION CO[rNTY BUILDING I~.~PECTION <br /> 3150 Lan3150 Lancas~ Dr. I~E - Su~C <br /> Sa~m, Or~on 9?305 <br />8:00 am - 4'30 pm 24 ~, ]nsp~tinn Linc 373-4427 FAX 588-'/948 <br /> <br /> 7 <br /> <br /> A. R~ldeatial Per Unit, Service lacladed <br /> <br />lions C~st (~a~h) Sum <br /> x S110.00 ~$ 4 <br /> x $ 20.00 =S__ <br /> x S 30.00 = $__1 <br /> <br /> x $ 52.00 = $ 2 <br /> <br />B. Sctwlces or Fccder~ (Ih)es not Include branch Circuit, sec Section D) <br />Installation, Alteration, or Relocation ~,~ <br />200amI~ ~ x $65.~0 = $,- 2 <br />201 amp~to400ampz x $80.00 = $ 2 <br />401 am~ ~o 600 amp~ x $130.00 = $ 2 <br />601 aml~ ~o 1000 am~ x $170.00= $ 2 <br />Ov~ 1000 amp~of volt~ x S390.00-- $ 2 <br />l~x~no~Only x $ 55.00 = $ 2 <br />C, Temporary Servke~Feeden~ <br /> <br />200amps er kaa x $45.00 -- $ 2 <br /> <br />401 ~ to 600 amps x $110.00- $ 2 <br />Over 600 ampa er 1000 volts, see "B' above <br />O. Branch <br /> <br /> a) ~he foe for branch cimuh with the ou~has~ <br /> ofgefviceorFecdtwFetEaBrCit x $ 3.00 -- $ <br /> b) Th~ fm for h~anc, h cimui~ wi~ou t ~ <br /> <br /> FiraBramhCix~i't x $50.00 -- $ <br /> EachAdditlamlBfanchCimuit x $ 3.00 - $ <br /> F~ Mbtellaatom (Servke or Feeder Not lutluded) <br /> Eachpumpo~irtipfionciml~ x $55.00 = $___2 <br /> EachSigno~Outli~Li~tiag x $55.00 =, $.~_2 <br /> Signal Circuit(s) of ~ Limi~ F.4m~ <br /> Alt~afi~ of Fztm~ion x $ 55.00= $ 2 <br /> F. Eada Addltioul lnaptetion, over the allowable <br /> In aay of the above, per lu~pt~tioa x $50.00= $ <br /> <br /> Pack of I 0 labcl$ (~ $10.00 cach <br /> (Sold o~y to ~ <br /> IL ladn~trlal Plan! x $62.50 / hr = $ <br /> Oa~fwo Family Dwelllail Fee: Sq· Fcct x $ .09 ~ $ <br /> <br /> I~llln~ Permit Lab~h (For ~ia~le Family I)w~ilia~l Only) <br /> OTHER, lu required by the Building Official $ <br /> <br />TOTAL $ <br /> <br />5. FEES <br />Al. Enter Total Fees from Section #4 <br />A2 Add State Surcharge 605% x Al) <br /> <br />SUBTOTAL: <br /> <br />B. Enter 30% of lineAl for PISa R~view <br />C, Investigation Fee, ifrequi~d <br />D. R¢inspec~on F~ ($50.00) <br />E. Additional Plan Review (62.50&r, <br /> minimum on,-half hour) <br />F. lnspex:tion for which no fee is specifically indical~d, <br /> ($62.50/hr, minimum one hour) <br />G. in~I~-~6on Outsi~ Nomufl Business Hours, <br /> $62.50&r, minimum two hours) <br /> Pt t <br /> TOTAL AMOUNT <br /> <br /> <br />