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[,FOI~FF~CE USE ONLY <br /> Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 ~n - 4:30pm <br /> COd~-A-Phoa~: 555-7904 <br /> FAX: 588-794S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-RE~UNDABL~ AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />20. FOR OWNER INSTALLATIONS <br /> <br />M~dllng Address Phone <br /> <br />C[tytS~te~p <br /> <br />The installation is being made on property I own which is no~ intended for sale, <br /> <br />Owners Signatum <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service 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 does not suspend the <br />required submission of Ftghting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Date: <br /> <br />Permit No. <br /> <br /> Issued by: <br /> <br />4. FEE SCh~EDULE (Complete md enter to~al in Al below) <br /> <br /> Number <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> 1 <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> 1000 sq. ft. or less $85.00 4 <br /> Each ad.riced 500 sq. ft. <br /> or po~on tbereof $15.00 __ <br /> Limited Energy $20.00 -- <br /> Each Manuf d Home or Modular <br /> Dwelling Servic~ or Feeder $40.00 -- 2 <br /> <br />B. Services or Feeders (Does not inleude branch circuits, see section D) <br /> <br /> Installation, Alterations er Rdoeatlon <br /> 200 amps or less $50.00 <br /> 201 amps to 400 amps $60.00 <br /> 401 amps to 5~0 amps $100.00 <br /> 601 ampa to Iff00 aml~ $130.00 <br /> Owr 1000 amps or voRs $~00.00 <br /> Reconnect only $40.00 <br /> <br />C, Temporary S~-vices/F~d~s <br /> <br /> 200 amps or less $~5.00 <br /> 201 amps to 400 amps $~.00 <br /> 401 raps to 600 amps $80.00 <br /> Over 600 amps or 10~0 volts <br /> see "B" above <br /> <br />I). ~rauch Circuits <br /> <br /> a) The fca for branch dreuits wi~ <br /> pun~ase of service or feeder fee <br /> <br /> Each branch circuit $2.00 <br /> <br /> b) The fee for branch circuts without <br /> purchase of service or feoder fee <br /> <br /> Each additional bran~ circuit ~ $2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Include~) <br />Each pump or irriga~on circle $~0.00 <br />· Each sign or outline lighting $40.00 <br />Signal cL~euit(s) ~ a 1LmRed energy <br />panel, alteration or extension $40.00 <br /> <br />F, Each additinnal Inspoction <br />over the allowable in any of the <br />above, per Inspeetlon $35.00 <br /> <br />0. Minor Installation Labels <br />Pack ~ 10 labels @ $5.(}0 each $,50.00 <br />(sold only to electrical conlractors) <br /> <br />H. Otber <br /> (As required by Building Officia0 <br /> <br />5. FEES <br /> Al. Enter t~al of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subto~l <br /> <br /> B. Enter 25% ofllnc Al for Finn Review <br /> (Sec. 3), if required <br /> C. InvestigationFee (ff r~quirea) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />