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[~O'R OFFICE USE ONLY <br /> Receives <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />phone 555-5147 8100 am - 4:30pm <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: ~I~tON (~O~N~T.¥ . <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Desc~v6on lOtS 1,,~ 2- BLOC!< ~, 0¢ th9 Pst~,on <br /> Addition to Detroit. <br /> <br />FERM1TS ARB NON-'I~qSFBRABLB AND NON-REFUNDAB LE ~ <br />EX~E IF WORK iS NOT STARTBD WI~ 180 DAYS OF ISSU~C~ <br />OR IF WO~ I~ SUSP~DBD FOR I80 DAYS. <br /> <br />%A. CO~'RACrOR IN~ALLATION ONLY <br /> <br />Contractor's Board Rcg, ~qo. [ Job No, <br />Signam~' of SupeeAsing Electrician <br /> <br />Phone No. <br /> <br />P~op~nyOw.~ ?iarvin & Harilan Hq,fey <br /> <br />MaiHngAddms~ 1848 Kent Ave. Phone 769-7236 <br /> Stayten, OR 97~3 <br />City/S~a~/~p <br /> <br />Thc installation is being made on property I own which is n~ intended for sale, <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 required by the Oregon Stractural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4. FEE SCHEDULE (Comple[~ and enter total i~ A 1 below) <br /> Number of Inspections <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> Servic~ Include~l: Items Ce~t (e~l~) Sum <br /> <br /> ~000 s ft- cat less $85,00 4 <br /> Each ildltiolaal' 500 sq, <br /> e¢ poalon thereof .... $15.00 <br /> Lflnited Energy $~0.00 -- 1 <br /> Each Manufd Home or Modular <br /> D~vcl~ing Sef'do~ or Feeder $40.00 __ 2 <br /> <br />B, Services or Feeders (Does not inlcudc branch ¢ircttits, sec section D) <br /> Installation, Alterations or Relocation <br /> <br /> 50 00 <br /> 200 amps or le~s 15~60:00 <br /> 201 amps to 400 amps ~ <br /> 401 amp~ to 600 amps $100.00 <br /> 031 amp~ t~ 1000 amps ~ $1~0,00 <br /> Over 1000 amps or volts $300,00 __ <br /> Re~opmcct ~dy ~ $40,00 <br /> <br />C. Temporary ServieesfFeea~ws <br />Installation, A neratioe, or Relocation / ~e.~.~-~ <br />200 arnps or loss $~S.00 <br />~01 amps to 400 amp~ $40.00 <br />401 amps to 600 amps $80.00 -- <br /> Over 600 amps or 1000 volts <br /> scc"B'above Temp. Service will <br />D. graneb Ci~i~er requi rements attached. <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch circ~fils ~ <br /> <br /> Each brach cimit $2.~ <br /> <br /> b) ~ f~ for ~nch dinars wi~out <br /> ~rchase 9~' ~ice or feeder fee <br /> <br /> F~t branch cim~it <br /> Each ~d~tlon~ branch e[rclfi~ $2.00 <br /> <br />E- Mlscellan~u~ (Service or Feeder Not Included) <br /> ~& ~mp Or iffiga~m ~rcl¢ $40.00 <br /> <br /> Sig~lal ci~uit(a) or a ~[ed one~y <br /> ~nel, alterati~ ~ ext~sion $40.00 <br /> <br /> a~m, p~ Ins~c~oa $3500 <br /> <br />O. Minor lns~llatlon Labels <br /> Pack ~ 10 la~h ~ ~,00 each <br /> <br />H, ~her <br /> (As required by Buildln$ Officio <br /> <br />5, FEES <br /> <br />$ 36,75 <br /> <br />Al, Enter tcXai of fee~ imm Sec, ~14 <br />A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B, Enmr 25% of ~le A 1 for Plan Review <br />(S~, 3), if reff~t~ $ <br />C, ~vesfigafion b'ee (ff mqu~d) $ <br />D, Rcinspcc~ Fe~ ($~.~) $ <br /> <br /> <br />