Laserfiche WebLink
FOR. OFFICE USE ONLY <br />Received by: <br />Date: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, i through 5 <br /> <br /> P~ ~E NON-'I~NS~RAB~ ~ NON-~AB~ ~ <br /> E~E W WORK 15 NOT STARED ~ 180 DAYS O~ I~SU~CE <br /> OK ~ WO[K [S SUSP~ED FOR lse DAYS, <br /> <br />2A. CONTRACTOR INffrALLATION ONLY <br /> <br />Mailing Address <br />Property Owncr <br /> <br />Contractor's Boal~l Res, No, <br /> <br />Signatu~ of Supervising Electrician <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Prol~rty Owner <br />Mai~ng Address ' Phone <br />City/siatcf~p <br /> <br />The installaQon is be[ns made on progeny I own whlch is n~X inteaded for sale, <br /> <br />Ownets Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> SB and stibmit two (2) sets of plans and specifications with <br /> this application. <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Code-A-l~ono: 588-7904 <br /> F~X: 588-7945 <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 />MC 15-34 11/91 <br /> <br />SITE#: ,M,,~, ~ .0 lt}~rmitu°- <br />iSSU ed ~JlI.~.[N.(~ INSPF~CTION <br /> <br />4. FEE SCHEDULE (Complete and enter [olal B ^ 1 below) <br /> <br /> Number of Inspections p~ permit allowed <br /> <br />A. <br /> Residential <br /> Unit <br /> 1 <br /> Service Included: items Cost (each) Sum <br /> <br /> I000 sq, f~ or leas $85.00 ........ 4 <br /> Each ad&t[onal 500 sq, ~. <br /> or Purdon Sit.at $15.00 <br /> IJmlmd Ih'rangy __ $20.00 __ 1 <br /> l~ach M~nnt'd I-Iomc or Modular <br /> DwclEng Service or Feeder $40.00 __ 2 <br /> <br />E. Services or Feeders (Does not inlcude blanch cwcults, sec section D) <br /> <br /> installatlon~ Alterations or Relocation / <br /> 201 ~nl~ to 400 amps <br /> 401 ampa m 600 amps <br /> (~01 amp~ to 1000 amps <br /> Ovcr 1000 amps or volts <br /> Reconncct only <br /> <br />C. Temporary Services/Feeders <br /> <br /> 201 ~nps to ~ amps <br /> <br /> Over 600 amps or 1000 voltq <br /> <br />D. Branch Circuits <br /> <br /> a) The fcc for branch clrcaits with <br /> Pumhas¢ of se~ic~ or feeder- fe~, <br /> <br /> Each branch c~rcult <br /> <br /> b) The f~ f~ branch clrcuts without <br /> <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Nnt In/eluded) <br /> Each l~mp or irrigation cir*l~ <br /> Each s~Sn or outl[nc lighting <br /> Signal circuit(s) or a limited energy <br /> ImneI, ~lterafion or extcnslon <br /> <br />F. Each additional Inspection <br /> over the allowabl~ in any of the <br /> <br />G. Minor Installation Labels <br /> Pa~k of 10 labels @ $5,00 each <br /> (,~old only to electrical contractors) <br /> <br /> ( A~ r~quired by Building Official) <br /> <br />,50.00 <br />~60.00 <br />$100,00 <br />$130.00 <br />$30600 <br />$40.00 <br /> <br />$35.00 <br />$40.00 ,, 2 <br />$80.00 <br /> <br />$2,00 <br /> <br />$35,00 <br /> $2.00 <br /> <br />$40.00 (~-~ <br />$40.00 __ 2 <br /> <br />$40.00 __ 2 <br /> <br />$35,00 __ <br /> <br />$$0.00 <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sca, #4 <br /> A2, Add 5% sumharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, ~ter 25% of llnc A1 for Plan Review <br /> (Sec. 3), if rcq~red <br /> C. InveatigationF~e (if required) <br /> D, Re[nspecilon Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No, <br /> <br /> <br />