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FOR OFFICE USE ONLY <br />Received by:~ <br /> <br />1. LOCATION OF INSTALLATION <br />~ob Add~s~ J~' <br /> <br /> MARION COUNTY BUILDING INSPECT,~ <br /> Salem, O~gon 97301 <br /> Phon¢ 5~odS!-AS_~ 4pt7 8:on~%~_~ 49~4~ 0pta <br /> ~: 5ss-v~s SITE <br /> I <br />~LECTRICAE PERMIT APPLICATION I Date: <br />P/ease complete all Sections, I through 5J Issued <br /> <br />Cross <br /> <br />PERMITS ARE NON-TRANSFERAgLE AND NON-RBFUNDABLI~ AND <br />EXPIRE IF WORK IS NOT STARTED Wrrl-llN 180 DAYS OF ISSUANCI~ <br />OR iF WORK I$ SUSPENDED FOR 1 S0 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Supervisors License No, t Phone No. <br /> <br />The installation is being made on propc~f~y I own which is nc~ intended for sale, <br />lea~e, or rent. <br /> <br />Owner's Signature <br /> <br />3. PI,AN REVIEW SECTION <br /> <br />We will provide pl,m ~view 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 ut' lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC/5-34 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Irons Cost (each) Sum/ <br /> <br /> 1000sq, ft, ~ less $8&00 ~ <br /> g~h a~tional 5~ ~q. ft. <br /> m ~ffim ~cmof $15.00 <br /> ~imd E~y $20.00 <br /> <br /> Dw~ Se~ or Feeder $40,00 <br /> <br /> Ins~llaOon, AIt~ations or Reliction <br /> ~ amps ~ less ~S0.O0 <br /> ~I amp~ to 4~ raps $$0,00 __ <br /> ~1 ~tps to 6~ amp~ $]00.00 <br /> ~1 amtpala m 1~0 amps $130,00 <br /> ~er 1~ ~ps or volts $300.00 <br /> Re.ancot ~dy $40.00 __ <br /> <br />C, Tempnrary Service~ders <br />Installatlon, Alteration, or Rel~anon <br />2~ amps or less $~,00 <br />~I ~ps to ~0 amps $40,00 <br />401 ~pa to ~0 amtpss $~0.00 <br /> <br /> p~q~gse,of sewic~ or feeder fee <br /> Each brach circuit $2.00 <br /> <br /> b) The f~ f~ bran~ 6roms wi~out <br /> ~rcham of mw~ce Qr ~eg~ <br /> Fkst brauch ~rcui~ / $35.00 ~ <br /> Each additimal branch elrcuk ~ <br />E. Mi~ellancmus (Service or Feeder Not Inelo~ed) <br /> Each ~mp or iffiga~ ~tde $40.00 <br /> <br /> S~gnal mrcmt(a) or a ~m~ ed enemy <br /> <br /> a~ve. ~ ~pecfim $35,00 <br /> <br /> Pack of 10 lulls ~ $5.00 ea~ $S0,00 ..... <br /> Cold only to electr&al contractors) <br /> <br /> (As required by Building Offic~0 <br /> <br />5. FEES <br /> Al. ~.mer Iotel of fee~ from Sec. #4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> (Sec. 3), if requireA <br /> C. Invcstlgatlongee (if requjred) <br /> D. Relnspcetlm Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No, <br /> <br /> <br />