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VOR om%J'us om <br /> Received by:. _ <br />I Date: _ <br /> <br /> ELECTRICAL PERMIT APPLICATIOh <br />J Please complete all Sections, 1 throb <br /> / <br /> <br /> 1. IXICKUION OF iNb"rALLATiON ' <br /> <br />pER1VffI'8 ARE NON-'IRAZ'S FERABLE AND NON-REFUNDABLE AND <br />~XPIRE IF WORK IS NOT STARTAD WITIIIN 180 DAYS OF ISSUA2q'CE <br />OR I9 WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR iNSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Mailing Address phone <br /> <br />City/State/Zip <br /> <br />The installation is being made on pmp~ny I own wblch is naa intended for sale, <br />lease, or rant. <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We wilt provide plan review service if you comple~ 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 />MC 15-$~ IU91 " ' <br /> <br />d:}>.c:> F'gox. ,l q <br /> <br /> MARION SDUNT¥ <br />uUILUING INSP£CI'ION <br /> <br />nd enter total in A 1 below) <br /> <br /> $15100 <br /> <br />macn Mamlfd l:tora~ or M~dular <br />Dwelling So,ce or Feeder $40,00 ~ 2 <br /> <br /> Services or Feeders (Does not ~lcude b~tlch circuit~, sec section D) <br /> <br /> ~ am~ or less $50.00 ~ 2 <br /> 201 amps to 4~ amps ~ $60.00 ~ 2 <br /> ~1 amps m 6tX) amps $100,00 ~ 2 <br /> ~1 am~ to I~0 amps $130.00 . 2 <br /> ~e¢ 1 ~ ~ps or volts ~ $300,~ ~ 2 <br /> <br /> 201 amps to 400 amps <br /> 401 m-ape to OX~ amtpaa <br /> Ovcr 600 amps or 1000 volts <br /> <br />D, Igranch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch 6mu~ts <br /> pumha~qe of service or <br /> <br /> ~ brmeh ~muit .... <br /> <br /> b} ~e f~ f~ blanch ~mut$ ~i~out <br /> <br /> Each additional branch drcoit <br /> <br />g. Mlseella~us (Service or Feeder Not Includ0d) <br /> ~ach ~mp or ~igafim altec <br /> gach sign or outline lighting, <br /> Signal circuit(s) ce a li~md energy <br /> <br />E Eacll additional <br /> <br /> a~ve, per Inspection <br /> <br />G. Minor Ins~llatlon Labels <br /> Pack of I0 ts~s ~ &5.00 <br /> <br />~. Other <br /> (As required by BuiMing Offieia0 <br /> <br />$35.00 <br />$40.00 <br />$80.00 <br /> <br />$2.00 <br /> <br />$35,00 ~ <br /> $2.oo <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 __2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> All Enter total of fees from S~c. #4 <br /> A2. Add 5% mreharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Revlew <br /> (Sec. 3), if reqnired <br /> C- Investigation Fee (if required) <br /> D, Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br /> <br />,, Receipt NOl <br /> <br /> <br />