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FOR OFFICE USE ONLY <br />Received by:_ <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION Date: <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 22~ High Sm3et NE ~ ~ ~ <br /> Salem, Oregon97301 l~l~ ~ ff ~ __~, ~ <br /> Phone 588-5147 8:00 ~*a- 4:30~111 <br /> L~n it No, <br /> <br />PEB3/RTS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTleD WITHIN 150 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Ptopeay Owner <br />Contra~tof~ Boa~ Reg. No, ~ ~ ~ob No. <br /> <br />2B. FOR OWNER IN,WI'ALLKI'IONS <br />Property Owner <br />Mailing Address Phone <br />City/St ate/Zip <br /> <br />'lEe thslal~tion is being made on property I own which b not intended for sale. <br /> <br />Owner's Si§natum ..... <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 lighting power calculations, plans, <br />and specifications when requi~<l by the Oregon Stroctm'al <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/9,1 <br /> <br />4, FEE SCHEDULE (Complete and enter total ~ A 1 below) <br /> <br /> Number of Inspectlot~s per permit allowed <br /> <br />A. <br /> Residential <br /> Unit <br /> Service Included: }tams COSt (~aeh) Sum/ <br /> <br />1000 sq. R. or less $a$.00 ...... <br />Bach ad~tiona1500 $q, E, <br />or po~o~ thereof $15.00 <br />Lhnll~d Energy $20.00 -- <br />Each Manufd l-lo~e o? Modt:lar <br />Dwelling Scr~ce or Fccdef $40.00 __ <br /> <br /> Installatton~ Altm'ations or Relocation <br /> 200 amps oc less I ., $$0.00 <br /> 201 amps to 400 ~tmp$ $~0.00 __ <br /> 401 amps to 600 amps $~00.00 __ <br /> 601 amr~ to 1000 amps $130,00 <br /> Over I000 amps or volts $300,00 <br /> Reconx~ect only $40,00 <br /> <br />C. Temporary Services/Feeders <br /> <br /> ~00 amps or less $~5,00 -- <br /> 201 amps to 400 amps $40.00 <br /> 401 amps ~o 600 amtpss SBO.O0 __ <br /> <br />D, Branch Circuits <br /> <br /> purcEasc of scr~Ac~ or feecO~? <br /> Each br~mch circuit $2.00 <br /> b) The fee for branch clrc ts .w, tho <br /> <br /> FLoat br~nch circuit $85.00 <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Servlee or Feeder Not Included) <br /> Each p~zmp or irrigafioo ei~cI¢ ,. $40.00 -- <br /> Each sign or Outline lighting $40.00 -- <br /> Signal circuit(s) o~ a limited energy <br /> paocl, alteration or extcmsion -- $40.00 __ <br /> <br /> over the allowable in any o~ the <br /> above, per Inspection ....... <br /> <br />0. Minor Installation Labels <br /> Pack of I0 labels @ $5.00 caeh $S0.00 <br /> <br /> ( A.~ requlr~d by Building Official) <br /> <br />5. FEES <br />A 1, Enter total of fees from Sec, #4 $ ~__.~) <br /> AZ. AddS% surchagge (,05xAI) $ c.~-O ~)( 3 <br /> <br /> Subtotal $, <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sca. 3), if requited $ <br /> C. TnvcstJSatlonFee (ffrequimd) $ <br /> D. Reinspecticm Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No.. ..... <br /> <br />$~ <br /> <br /> <br />