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FoR. ,OFFICE USE ONLY <br />llecewed by:_ <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> L LOCA'FION OFINSTALLATION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 585-5147 8:00 am - 4:30pm <br />Cod~-A-Phonm 5gS-7904 <br /> FAX: 588-7948 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> SITE#: '-~ <br /> Date: ~AiIIONCOUNI'¥ <br /> Issued b~l.UILDING INSPECTION <br /> <br />Cross St. <br /> <br />PERMITS ARB NON-'IRANSFERABLE ILND NON-REFUNDABLE A~D <br />EXPIRE IF WORK IS NOT STARTED WiTI I1N 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 18.0 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> /ObT Pho. · . -- <br /> <br />Pro~ay Owner "}) · ~ t z , ~e--./& ~ .~ <br /> <br />ProI~ny Owner <br />Mailing Address Phone <br />City]State/Zip <br /> <br />Thc installation is being made on properly I own which is not intended for sale, <br />lease, o~ <br /> <br />3, PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B sad submit two (2) ~ts of plans and specifications with <br /> this application. <br /> <br />This optional plan review program does not suspend thc <br />mquireA sabmission of lighting pOwer calculafioas, plans, <br />and spcaifications when required by the Oregon Structural <br />Speciahy Code, Chapter 53. <br /> <br />MC 15-34 1119] <br /> <br />FEE SCHEDULE (Colnplete and enter total in A 1 belOW) <br /> <br />A, Residential Per Unit <br /> <br />Raeh additional 500 sq, R. <br />or posen thereof <br /> <br />$85.00 ~ 4 <br /> <br />$1S.00 <br />$30.00 _ 1 <br /> <br />Each Manu£d I.Iomc or Modular <br />Dwelling Servtee or Feeder $40.00 -- 2 <br /> <br />B. Services or Feeders (Does not i~lcudc branch circuits, ~ee section D) <br /> <br /> Installation, Alterations nr Relocation <br /> <br /> 201 aml~ to 400 alBps <br /> <br /> 601 amps to 1BO0 amps <br /> <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 vol~s <br /> <br />P. Branch Circua-~ <br /> <br /> a) The fee for branch circuits 3y~h <br /> <br /> Each branch circuit <br /> <br /> b) 'Die fe~ for braneAl circuts wlt,~.oot <br /> W~rcha~¢ 9f ~ervine or feeder fee <br /> <br /> Each additional branch cimult <br /> <br /> Bach p~mp or irrigation clinic <br /> Each sign or outline lis_brimS . <br /> Signal eircuit(~) or ~n~it~f energ, y <br /> <br /> Pack of 10 labels @ $S,00 each <br /> <br /> ( AS required by Building Offlci~O <br /> <br /> ~$0.00 2 <br /> 60.00 ~ 2 <br />$100.00 -- 2 <br />$130.00 2 <br />$$00.00 2 <br /> $40.00 . 2 <br /> <br />$35.00 2 <br />$40,eo 2 <br />$80.00 __2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 2 <br />$40.00 __2 <br />$40.00 z/~LOtt2 <br /> <br />$35.00 <br /> <br />$5o.oo <br /> <br />5. FEES <br /> <br /> A2, Add $% surcharge (,05 x Al) <br /> <br /> (Sec. 3), if required <br /> <br /> D, Reln~pe~tion Fee ¢23,00) <br /> <br /> Receipt No, ,,, -- , <br /> <br />$ <br /> <br />$ <br /> <br /> <br />