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FOR OF~FICE USE ONLY <br /> Rec[ived by: <br />LDate: . <br /> <br /> E LECTRIOAL PERMIT APPLIC^TION <br /> Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> ' UILDIN EC iON <br /> <br />PERMi~ ARE NON-1ltANSFERABLE .adqD NON.I~FUNDABLE AND <br />EXP/RB 1F WORK IS NOT START!qD W/T/UN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUS ,FENDED FOR- 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER iNSTALLATIONS <br /> <br />Proparty Owner <br /> <br />M.a~l~g Addm*s Phone <br /> <br />Cky/Sta~d-/ip <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plar~ review service if you complete Section <br /> SB 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 Structural <br /> Specialty Cede, Chapter 53. <br /> <br />MC15-3411/91 Cf~oa.'~oo.o <br /> <br />4. FEE SCHEDULE (Complete and ~tec to~al in A 1 ~low) <br /> <br /> Number ~ lnap~tlons p~ pertolt ailed <br /> <br />A. <br /> R~lden~al <br /> ~r <br /> Unit <br /> S~lce Included: It.s C~t (~a~) Suml <br /> <br /> l~sq. ~. ~l¢s~ .... $~,00 ,4 <br /> E~ ad~l 5~ sq. ~. <br /> or ~ the~of $1 S,00 <br /> <br />B~ Maned I,Ime of M~uhr <br />Dw~g Se~ ~ Feeder $40.00 <br /> <br />~, Se~ ~ F~ers ~s not ~lcudc ~aneh clrc~ts, sca see~ D) <br /> <br /> Installation, Alterations or Relocation <br /> S0.00 <br /> 200 amps or less $ $60.00 <br /> 201 amps to 400 amps ~ <br /> 401 amps to 600 ampa $100,00 <br /> 601 amps to 10(X) amps $~80.00 <br /> Over 1000 amps or volts $~00,00 <br /> Reconnea only, $40,00 <br /> <br />12. Temporary Services/Feeders <br />Installation, Alteration, or Relm~atlon <br />200 amps or I*~s $85.00 <br />~01 mm~s lo 400 amp~ $40,00 <br />401 mnp; to 600 amps $80,00 <br />Over 600 ampa or 1000 robs <br /> <br />D. Branch Circuits <br /> Ne% An~ation, or .Eatt en sion Per Panel <br /> <br /> a) The fee for I~mqch cA~uits 3dill <br /> purchase of s.¢rvlee or feeder fee. <br /> <br /> Each branch circuit ~ $2.00 <br /> <br /> b) Thc fee for bnmch ~muts wi~out <br /> Imrcha*¢ Of"C~ic~ or feqdgr Ica <br /> <br /> F~[ bra~ch clmdit $~$,00 <br /> Each additional branch dmuit ~ $2.00 <br /> <br />E. Miscellaneouz (Servlc~ or Fetder Not Included) <br />Each pump or irdgati~ cird~ $40,00 <br />Each sign or outllne lighting $40,00 <br />Signal c~teuit(~) or a limited energy <br /> panel, alteration o~ ¢xumaion ~ $~0.00 <br /> <br />E Each atidBi0nal Inspection <br />over the allowable Lq any of the <br />above, per htspectlon $$5.00 <br /> <br />O. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50,00 <br />(sold only to elactrical cut, factors) <br /> <br />It. Other <br /> ( A,r reqtdred by Bg#ding OfflclaO ...... <br /> <br />5, FEES <br /> Al, Enter uxal of fees from See. #4 <br /> A2, Add 5% surcharge (,0~ x Al) <br /> <br /> Subtotal <br /> <br /> B. Ent,r25%oflineAl forPlan Review <br /> (Sec. 3), if required <br /> C, Investigation Fee (ff required) <br /> D. R¢~spactiqa Fee ($.l,5,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ z-~ <br /> <br />Receipt No, <br /> <br /> <br />