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'FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br /> I MARION COUNTY BUILDING iNSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 9730~ <br /> Phone 588-5147 8:0{~am. 4:301an <br /> Code-A-Phone; 555-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION "]' <br /> I <br />Please complete all Sections, 1 through 5 <br /> <br />SITE Permit No. <br /> JUL 0 6 Iq92 <br />Date: <br /> <br />ssued by' MARION CO~JN]'¥ <br /> ' BUILDtN8 NSPECl ON <br /> <br />LOCATION OF INSTALLATION <br /> <br />PEILMYiS ARE NON-TRANSFERABLE AND NON-Ri~FUNDABLE AND <br />EXPIRE II~ WORK IS NOT STARTED WiT~llq lB0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPS3NDED FOR 180 DAYS. <br /> <br />~A, CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSq'ALLATIONS <br /> <br />Mailing Address phone <br /> <br />Cliy/StatefZlp <br /> <br />Thc inst~,llation b b~ing made on property I own which iz not intended for gale, <br /> <br />3. PLAN REVIEW sECTION <br /> <br />Wc 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 Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4, FEE SCHEDULE (Complete and ~ntet lot,al ~n A l b~Iow) <br /> <br />A, Residential Per Unit <br /> <br />1000 sq. ft. or less <br />Each addilioaal 5130 ~q, fl, <br /> or IX)~lon thereof <br /> <br />.... $85.00 -- 4 <br /> <br />Limited Et~e~y <br />Each Manufd lime or Modular <br />Dwelling Service or Feeder $40.00 <br /> <br />B. Services or Feeders (Does nol. inlclade branch circuits, sec section D) <br /> <br />$15.00 <br />$~0,00 __1 <br /> <br /> Installatlon~ Al~ratJons or Relocation <br /> 200 amps or/ex~ ..... $50.00 -- <br /> ~01 amps to 400 amps $$0.00 2 <br /> 401 amps to 600 amps $100.00 2 <br /> 601 am~ps~to 1000 amps $130.00 __ 2 <br /> Over 1000 ~rnps or volts $300,00 ..... <br /> Reconnect only $40,00 , <br /> <br /> 200 amps or lc~s $35.00 -- 2 <br /> 201 amp~ to 400 amps $40.00 -- <br /> 401 amps to 600 amp~ $80.00 ..... <br /> <br /> New~ Al~ration, or Extension Per Panel <br /> <br />a) Thc fee for branch drcuils ~ <br /> <br /> Each branch circuit <br /> <br /> b)The fee for brat~eh clrcut~ wi~qtlt <br /> par¢ham of service o.r.f~ader fee <br /> <br /> First branoh circuit $85.00 <br /> Each addi6.onal branch ckcuit <br /> <br /> Each .p~.,,.mp or irriga0.oa elrcin ~ $40.00 2 <br /> Each sign or outllae lighting $40,00 -- <br /> Signal ¢imuit(~) or a limited energy <br /> <br /> over the allowable in any of th~ <br /> above, per Inspeclio~ ~ $;35.00 <br /> <br /> Minor Installation Labels <br /> Pack of I0 label, ~ $5.00 each $$0 <br /> <br />Other <br /> ( A,* required by Btlildln$ Official) <br /> <br />5. FEES <br /> Al. Enter total of fees free, Sec. #4 <br /> A2. Add 5% surcharge (.05 X A 1 ) <br /> <br /> Subtota{ <br /> <br /> B. Enter ~% of lhm A 1 for Plan Review <br /> (S~. 3), if ~ir~ , <br /> C. Inve~tigatlo~ Fee (if mq~imd) <br /> D, Rcinsp~fim Fee ($2530) <br /> <br /> 'i~TAL AMOUr' DUE <br /> <br /> Receipt No. <br /> <br /> <br />