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oreck. JsE ONLY <br />Received by:__ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High S~xeet NE <br /> Salem, O~egon 97301 <br /> <br />Phone 588-5147 8:00 ~ra - d:30pm <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br /> % [ <br /> <br />Date: <br /> <br />r.~sedptlon <br /> <br />F .ERMrrs ARE NON-TRANSFeRABLE AND NON-REFUNDABLI~ AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF I$SUANCI~ <br />OR IF WORK IS SUSPI~NDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INfiTALLATIONS <br /> <br />Pmper[~ Owner <br /> <br />Maillqg Address Phone <br /> <br />City/State/Zip <br /> <br />Thc installation is bolas made on property I own which is not intended for sale, <br /> <br />Owne[a Slgnatum <br /> <br />3. PLAN REVIEW SEC. TION <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 IX>wer 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 />4. FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number ~ff Inspectiuns p~ permit allowed <br />A.ServiceResidentlaIlncluded:]Per Unit Items Cost (each) S~m <br />1000 sq, ft, or le~s $85.00 __ <br />Each additional 500 scI, fi, <br />or pordon thereof $15.00 <br />Limited En~egy $20,00 ......... <br />Bach Manufd l-lome or Modular <br />Dwelling Service or Feeder $40.00 <br /> <br />B. Services or Feeders (Does not inleude branch circuits, see section D) <br /> <br /> Installation, Altexatlons or Relocation <br /> 50,00 <br /> 200 amp~ or less <br /> 201 amp~ to 400 amps <br /> 401 :traps to 600 amps $100,00 <br /> 601 amlpsls to 1000 amps $130,00 <br /> Over 1000 amps or volts $300,00 <br /> Recormeel only $40,00 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alteration, or Relocation <br />200 amps or less $85.00 <br />201 amps to400 amps $40.00 <br />401 amtpss to 600 amps $80.00 <br />Over 600 amps or 1000 vohs <br /> <br />D. Branch CireulL~ <br /> <br /> a) Thc f~ for branch circuit~ with <br /> <br /> Each branch circuit <br /> <br /> b~ ~'he f~ for branch circut~ without <br /> <br /> Each pump or irrigation circle <br /> <br /> owr die allowable ~n any of the <br /> above, per Inspection -- $35.00 <br /> <br />5. FEES <br /> <br /> A 1, 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 A1 for Plan Review <br /> (See. 3), if mqalred <br /> C. Investigatlon Fee (ff ~quired) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No, , .... <br /> <br />$__ <br /> <br /> <br />