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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 Higl~ Strec[ NE <br /> <br />PERMITS ARE NON-TRANSFERaBLE AND NON-REFUNDABLE AND <br />· EXlYlRE IF WORK IS NOT STARTED W1THIN 1 S0 DAYS OF ISSUANCE <br />OR IF WORK I8 SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />S~s~s N~nse No, Phone No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prop~ty Owner <br />MaUing Add.ss Phone <br />CityI~tateffJp <br /> <br />The installation ia being made on property I own which is net intended for sale, <br /> <br />Ownces Signature <br /> <br />3, PLAN REVIEW SECI'ION <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 lighting power calculations, plans, <br /> and specifications when reqnired by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br /> IN~r <br /> (C~plete ~ra[ m A 1 ~low) <br /> <br />A, <br /> R~ldenOal <br /> Per <br /> Se~l~ included: It~u Cost (each) <br /> <br /> 10ffissq dt ~less $65,00 <br /> Each a~&~ <br /> ~x~ffim thereof __ $15,00 <br /> ~ E~y $20,00 <br /> E~h Manufd ~m~ or M~lar <br /> Dwe~ng <br /> <br />B, $er~ or FeVers ~o~s not Nlcu~ branch cim~ts, see ~ecti~ <br /> Inmllaflon, Alterations <br /> <br /> ~1 am~ to 4~ ~ps ~ $60.00 <br /> ~l am~ m 6~ ~ps -- $100,00 <br /> ~1 am <br /> <br /> ~1 ~ps to <br /> 401~ ~to~am <br /> ~er 6~ ~ps or 1~ volts <br /> <br />D. Branch Cl~ul~ <br /> <br /> a) ~e f~ for ~eh ~m~ts with <br /> <br /> Each brach clmu~t $2,00 <br /> <br /> b)~ f~ fm bran~ ~mts wiffiout <br /> ~rchase <br /> <br /> Fimt branch cimuit $3S.00 <br /> Each addifionM bran~ ~muk $~,00 <br /> <br />E. Mi~ellan~u$ (Service or Feeder Not Included) <br /> ~ ~mp or <br /> Each sign or <br /> Sign~ clmui~(s) or a fi~ted enemy <br /> ~nel, almratm <br /> <br />E ~ch a4ditional Imp~tlon <br />~er <br />a~e, p~ ~s~cfim $35,00 <br />G, ~lnor I~s~llafion Labels <br />OoM only to el~ctri~l commctor~) <br /> <br />S. FEES <br /> Al, Enter total of fees from Sec, #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3). if reqtfircd <br /> C. lnvestigalionFee (ff required) <br /> D, Rcinspectlm Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, , .... <br /> <br /> <br />