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I FOR OFFICE USE ONLY <br />Received by:_ 220 High Smut NE <br />Date: Salem, Oregon 97301 <br /> Phone 588-51d7 8:00 ~al - 4:30pm <br /> Codc-A-phon*: 588-7904 <br /> ELECTRICAL PERMITAPPLICATIONI Date: <br /> Please complete all Sections, I through 5 ,~[p ~ 8 ~f~ Issued by: <br /> I. LOCATION OFINSTALLATION ~ARION CO <br /> <br />MARION COUNTY RUILDING INSPECTION <br /> <br />PERM]Tr~ ARE NON.I~J~NSFERABLE AND NON.KEFUNDABLE AND <br />EXPIRE I~ WORK IS NOT STARTED WITH]~ 180 DAYS OF ISSUANCE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Property Ownar <br />Ma[llng Address ' Phone <br />Chy/siatefZip <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> WC will provide plan Nview service if you complete Section <br /> 5B and submit two (2) se~s 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 Ccde, Chapter 53. <br /> <br />PermitNo. <br /> <br />~'"4'" SCHEDULE Com te ~md enter total }n A <br /> Number of Inspections per tmrmlt allowed <br /> <br /> A. Residential P~r Unit <br /> Service teelUded: Items Cost (each) Suml <br /> <br /> 1000 ,q. f~ or less $$5,00 <br /> Each additional $~0 sq. fl_ <br /> or p0~ic~l themof $~,00 <br /> Limlted Energy $20,00 __ <br /> Each Manufd Hotne Or Modular <br /> <br /> B. Sem, lte~ or Feeders ['Does not lalcude branch cn muhs, see section D) <br /> <br /> 201 amps to 400 amps <br /> 40I amps to 6~0 amps <br /> 601 aml~ to 1000 amp~ <br /> Over 1000 ~-nps or volts <br /> Reomumct enly <br /> <br />C. Temporary Services/FeVers <br /> <br /> 7.~ ~tmps or less <br /> 201 amps to 400 amp~ <br /> 401 araps to 600 ami~ <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Circuits <br /> <br /> a) The fe~ for branch cir¢~ls with <br /> purchase,pr service or feed~ee <br /> <br /> b) The f~c for b~anch cireuts without <br /> <br /> Flint branch circuit <br /> Each addltionld branch ci~ult <br /> <br /> Miscellaneous (Service or Feeder Not Included) <br /> Each gamp or i~figation circla <br /> Eaoh sign or outline lightlng <br /> Signal ~reoit(s) or a limimd energy <br /> <br /> over the aEowablc ia any of the <br /> above, I~r Inspocfou <br /> <br /> Pack of i0 labels @ $5,00 each <br /> (sold only lo electrical contractors) <br /> <br /> Other <br /> (As required by Building Official) <br /> <br /> ~50.3O <br /> 60.00 <br />$100,00 --2 <br />$130.00 -- 2 <br />$300.00 2 <br />$40.00 <br /> <br />$35,00 --2 <br />$40.00 <br />$80,00 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.oo <br /> <br />$40.3O --2 <br />940.00 --2 <br /> <br />$40.00 __2 <br /> <br />$85.00 <br /> <br />$5000 <br /> <br />5. FEES <br /> Al. Enter tmal of fees f~c~n Scc~ #4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of l~ne A 1 for Plan Review <br /> (Sec, 3), if required <br /> C. InvesdgationFce (if requital) <br /> D. Reinsi~ctica Fcc ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />MC 15-34 11191 Receipt No. .. <br /> <br /> <br />