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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Omgo~,97301 <br /> <br /> Phcrne 588-5147 8:00 am - 4:30pm <br /> Code-A-Pbgc: 585-7904 <br /> FAX: sgS-7~4g SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDAB LE AND <br />EX'P~E 1~ WORK IS NOT STAP, TED WTFI~N I80 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> - <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Propsay Owner <br /> <br />Mailing Addn~.ss Phone <br /> <br />City/State/Zip <br /> <br />installation iv being made on propet*y I own which is no[ int~odod for sale <br /> <br />3. PLAN REV'fEW 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 lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br />A, Residential Per Unit <br /> Service Included: <br /> <br />1000 sq, fn ~less <br />Each a~iditional 5{30 sq. <br /> or poaion th¢~of <br /> <br />$85.00 -- 4 <br />$1~.oo <br /> <br />Limited Energy $20,00 __ 1 <br />Each Manufd Home or Modular <br />Dwelling Scrvl~ or Feeder $40.00 -- 2 <br /> <br /> Installation~ Alterations or RelOCation <br /> <br /> 200 amps or less ~;50,00 <br /> 201 amps to 400 amps $60,00 <br /> 401 amps to 600 amps $100.00 <br /> 601 snips to lO00 amps $130.00 <br /> Over I000 amps or volta $000,00 <br /> Reconnect only $40,00 <br /> <br />C, Temporary ServleesLPeeders <br />Installation, Aneratin~ or Relocation <br />200 amps or less $0S.00 <br /> 40.00 <br /> 201 amPSmps to 400 amps $$80.00 <br /> 401 am sto600 arops <br /> Ovc?00 amps ot 1000 veils <br /> <br />D, Branch Cireui~ <br /> N~, AIteration~ or Extension Per Panel <br /> <br /> a) Th~ fe~ for branch d~tdts with <br /> <br /> Each branch circuit <br /> <br /> b) The fee for branch circms ~ithout <br /> <br /> First branch clrcuit <br /> Each additional bnmch circus <br /> <br /> Miscellaneous (Service or Feeder Not Included) <br /> Each l~mp or irrigation <br /> Each sign or outline lighting $40,00 <br /> Signal circuit(s) or a limited ~ncrgy <br /> panel, alteration or extension $40.00 <br /> <br /> ovar the anowabin in a)~y of the <br /> above, I~r Inspection -- $8~.00 <br /> <br /> Pack ~ 10 labels @ $5.00 each $60.00 <br /> <br /> Other <br /> (As required by Buildi~:g Offlcla0 <br /> <br />5. FEES <br /> Al, Enter total of fees from Sec. #4 <br /> A2, Add 5% surcharge 605 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% o£ llne A1 for Plan Review <br /> (Sec. 3), if required <br /> C. [nvestigadonFce (if teqaimd) <br /> D, Reinspectlon Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br />MC 15-34 11/91 <br /> <br /> <br />