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FOR O~FICE USE ONLY <br />Received by: <br />Date: <br /> <br /> ELECTRICAL PERMITAPPLICAT[ON <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 /> Phons $88-5147 8:00 ~ - 4:30pm <br /> Code-A-Phone: $85-7904 <br /> FAX: 55S-V94S SITE #; <br /> <br />Date: <br /> <br />Issued by: <br /> <br />PermitNo. <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />P F2~.M I'I'S ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE iF WORK IS NOT STARTED WI'T'fllN 180 DAYS OF ISSUA2q'CE <br />OR [F WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A, CON'FRACTOR INSTALLATION ONLY <br /> <br />Contractors, ao~a~,No.~, /0 ~ ,J°bN°' 7 , ~ <br />Supe isor'sDmnseNo. /0 ~7 5 [Ph°neN°'39~7~9 <br /> <br />2B. FOR OWNER INbq'ALLATIONS <br />Prol~:lty Owner <br />Mailing Addres~ Phone <br /> <br />City/State/ZAp <br /> <br />The imtallafion is being made on properW I own wMeh j* nm intended for sma. <br /> <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 s0bmission of lighting power calculations, plans, <br />*nd spe~ ifications when required by the Oregon Structural <br />S. peciagy Code, Chapter 53. <br /> <br />4. FEE SCt~EDULE (Complete and enter total in A1 below) <br /> <br />A. R~iden~al Per Unit <br />Se~ice locluded: It~s Cost (each) Sum/ <br /> <br />I ~ sq. ft. or l~s $85,00 ,-, 4 <br /> <br /> Ins~allatlon, Alterations or Rdocatlon I $,50,00 <br /> 200 amps of less <br /> 201 amps to 400 amp~ $60.00 <br /> <br /> ~i am~ to 1~ am~ $180.00 <br /> Over 1~ ~ps or volts $800.~ <br /> Re~nnect ~ly $40,00 <br /> <br /> 2~ amps or less $35,00 <br /> 401 ~p~ to~) am~ $~,00 <br /> <br />D. Branch Cireui~ <br /> <br /> a) ~e fm for branch cim~ts <br /> <br /> ~ch brach clrcui[ <br /> <br /> First b~nch circuit <br /> Each additio~M branch circuit $2.00 <br /> <br /> a~. ~r In,chon $35,00 <br /> Pack of 10 la~Is ~ 85.~ each $50,00 <br /> <br /> ( A~ mq~red by Building opic&l) <br /> <br />5. FEES <br /> <br />Al. Entcrtmalof fees from Sec. #4 <br />A2. Add 5% surcha~.e (.05 x Al) <br /> <br /> Subtotal <br /> <br />B, Enter 25% of linc A I for Plan Review <br /> (Sec, 3). if required <br />C. InvsstigationFee (ffmquimd) <br />D. Rcinspecuon Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MC 15-34 11/91 Receipt No. <br /> <br /> <br />