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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 285 Chumh St. NE - Room <br /> S*lem, Oreaon 9730 I <br /> <br />Plume ~SS-~ 147 8.00 ~m - 4:~ <br /> ~-A-~: 588-7~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />SITE #: <br /> <br />Issued by: <br /> <br />!, LOCATION OFINS~ALLATION <br /> <br />pERMITS ARB NON-TR.a~SPER~BLI~ AND NON-REPUNDABLB AND <br />EXPIRE IF WORK IS NOT STAR'r~D WI'TH~*{ iso DAYa OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Prapcrty Owner <br /> <br />Mailing Address [ Phone <br /> <br />City/S~t~/Zip <br /> <br />~c [nst allatlo~ is b~ing mad~ cn t~r~y I own which is nm intended for sal~, <br /> <br />Owner's Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan r~view s~rvice if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program dona not suspsnd the <br />required submission of lighting power calculations, plans. <br />and speclficallons when r~qulred by thc Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC i5-34 8/94 <br /> <br />4. F~E SCHEDULE (Complete ~d enter totalin A i b~low) <br /> <br />A. <br /> Unit <br /> / <br /> ~ke [nc~d~: It.s Cmt (e~) S~/ <br /> <br /> Erich ad~fi~al 5~ ;q, fi. <br /> $~.oo <br /> ~ M~fd H~c or M~u~r <br /> <br />R. Se~ ~ F~ers ~ nm ~Icode branch circ~ts, s~ sgod~ D) <br /> <br /> ~less f $~.00 ~ 2 <br /> ~1 ~ to 4~ps , $~,00 2 <br /> <br /> ~er I~ ~ps or vol~ ~0,~ 2 <br /> R~noct mly $40,~ 2 <br /> <br />C, Tempornry Servh:es/F~'ders <br /> Insl~lhflnn, Alteration, or Rt4o~ation <br /> 200 nmps or le~s <br /> 201 amps to 400 ~nps <br /> 401 amps to 600 amps <br /> Over 600 ~-nps or 1000 volts <br /> <br />D. Branch Clrmlt~ <br /> Hew, AR~'~flm% or Eaitenslon per Panel <br /> <br /> ~) <br /> <br /> Ea~ br~nch circuit <br /> <br /> b) ~he fe~ f~* branch iii-cuts without <br /> ourchase of service or feeder fee <br /> <br /> Plrst branch cb~gt <br /> ~ch addlgo~al branch circoit <br /> <br />E, MIscellmneoos (S.rvic~ or l~eeder Not Included) <br /> S~saal tieR(s) ~ a U~ <br /> <br />F. ~ch addlUonal [nsp~tl~ ~tf te I~owabl~ ~ any <br /> <br />G. Minor lm~llaflon <br /> <br /> &oM only fo ~lec~i~l comractor~) <br /> <br />H, ~her <br /> <br />35.00 2 <br />40.00 2 <br />80.00 2 <br /> <br />~40.00 2 <br />40,00 2 <br /> <br />$40.00 2 <br /> <br />$3~.00 <br /> <br />SSO,00 <br /> <br /> 5, FEES <br /> Al. ]inter lO. al of fees from Sec. #4 <br /> A2. Acld ~ ~urcharg~ (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25~ o~ Une Al for P]~n Review <br /> (Sec. 3), if <br /> C. Inv~tlS~don Fee (i~ required) <br /> D. Rein~pecfm <br /> <br /> TOTAl, AMOUN'r DUB <br /> <br /> Receipt No. <br />' J.:3 q-I:a $~-IDR O[I <br /> <br /> <br />