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FOR OFFICE USE 9NLY I <br />Received by:~.~c~I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phon~: 588-7904 <br /> FAX: 58s.7945 ~ITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> 1. LOCA'FION OF INb~I'ALLATION <br /> <br />Date: <br /> <br />Issued by: <br /> <br />PermitNo, <br /> <br />St. <br /> <br />?ERMIT?:d ARB NON :IRANSFERABLE AND NON,REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHII'i' 1 $0 DAYS OE ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INS*FALLATION ONLY <br /> <br />SignatumofSupe~vi~thg Electrician ~ ,~¢w~%*~,- <br /> <br />Supe~i$of ~ Linense No. ~ I~.~, ~ <br /> <br />2E. FOR OWNER INSTALLATIONS <br />Property Owner <br />Mailing Address Phone <br />CJty/$tatefZ[p <br /> <br />The installation is being mad* on pmpe~y I own which is not intended for sale. <br /> <br />Owner's Signature <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 submission of lighting power calculations, plans, <br />and specifications when required by the Osegon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 ]1/91 <br /> <br />4. FEE SCHEDULE (Complvte ~md eater tol~I in A i below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Reeldenflal <br /> Per <br /> UnR <br /> Service Included: Items Cost (each) Sum <br /> <br />10O0 sq, fi, or less $85,00 -- <br />Each additional 500 scl, ft. <br />or portion diereof ..... $15.00 <br />Limited Energy $20.00 __ <br />Bach Mannfd lime or Modular <br />Dwelling Earvic~ or Fc. ode. r $40.00 -- <br /> <br />B. Ser~,lces or Feeders (Does not inlcode branch cimults, see section D) <br /> <br /> Installation, Alterations or Relocation <br /> 200 amp~ or less <br /> 201 aml~ to 400 amps <br /> 401 amps m 600 amps <br /> 601 am~psl'to 1000 amps <br /> <br /> Reconnect only <br /> <br />C+ Temporary ServicesACeeders <br /> <br /> 200 amps of less .... $35.00 <br /> 201 amps to 400 amps $40.00 <br /> 401 am s to 600 am ' $80.00 <br /> O~er ~>~ amps or i~00 vol, s <br /> <br />D- Branch Circuit~ <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) 'I~e fee for brauch circtfits with <br /> purehaxe of service or fee~ler <br /> Bach branch circuit ~ $2.00 <br /> <br /> b)'i3)e l'e~ for branch t~ctlts widiout <br /> .po.]chase of service or feeder fee · <br /> <br /> First branch circuit $85.00 <br /> Each additional branch circuit <br /> <br />E. MiSCellantq)ua (Service or Feeder Not Included) <br />Each pump or irrigation circle <br />Each sign or outline li.ghilng $40.00 <br />Signal circuit(s) or a hmhed energy <br />panel, alteration or exum;ion $40,00 <br /> <br />E Each additional InSpection <br />over the allowable in any of the <br />above, per Inspection SSS.00 <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each <br /> <br />H. Other <br /> ( As required by Build,ns Offlc~al) <br /> <br /> 50.00 2 <br /> ~o.oo 5~ <br /> <br />$100,00 . ~ <br />$130,00 3 <br />$300,00 2 <br /> $40,00 __2 <br /> <br />5. FEES <br />Al, Enter totM of fees from 8¢c. #4 $ ~2~- <br />A2. Add 5% sm'charge (,05 x Al) $ ~ <br /> <br /> Subtotal $ <br /> <br /> B- Eat*r25% of lineAl for PlanReview <br /> (See. 3). if ~¢tir~41 ~ $ <br /> C- ~vest~gationFee (if reqoimd) $ <br /> D. Reinspectica Fee ($25,00) $ <br /> /?.~_ <br /> TOTAL AMOUNT DUE $ ~ <br /> Receipt No. -- ,,,, <br /> <br /> <br />