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FOR. OFFICE USE ONLY <br /> Received by: <br />~Oate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 Big~ Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:[IO ~a - 4:30pm <br /> C~e-A-Phon~: 588-7~04 <br /> F~X: ~S$-7~4S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />I Date: <br />, Issued by: <br /> <br />PermitNo. <br /> <br />1. LOCAT/ON OF INSTALLATION <br /> <br />PAA~'I~ ARE NON-~S~B~ ~ NON-~A~ ~ <br />~A ~ WO~ IS NOT STAATF~ W~ ~se DA~S OF ~SU~CE <br />O~ IF WO~ IS SUS~AD FOR [ 80 DAYS. <br /> <br />PARI':;'. I N EI.._EI;;:-I-R :f B ~ I NC. <br />:20250 S MOLALLA AVENUE <br />f.)REGON C:['T'Y~ OR 97045 <br />2,46.---130 1 <br /> <br /> CON'I"RAC"rORS L ICt!SNSE $]~ 34-4C <br /> CON'I"I:,:ACTORS BOARD I,E= :1~: 35151 <br /> SUPERVISOR ~M= 1313-S <br /> <br />S~'°" U'"'e N°' l~ N°' <br /> <br />28. FOR OWNER INSTALLATIONS <br /> <br /> Pro.ny Owner <br /> <br />I _ Ma/Ii~s AddI~sS Phcmc <br /> City/State/Zip <br /> <br />The iust~lhdon is I~g~g mad~ on prop:ny I own wh/ch is nrg ~nrcndcd for <br /> <br />We will provide plan review service if you complete Section <br />513 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 Co6~, Chapter 53, <br /> <br />MC 15-34 H/91 <br /> <br />4. FEE SCHEDULE (Complete and ~mwr tome ~ At be, low) <br /> <br /> Numb~_w of Inspections per permit allow~l <br /> <br />A. <br /> Re~identla! <br /> Per <br /> Unit <br /> ! <br /> Service Included: It~rns Co~t (each) Sum/ <br /> <br /> 1000 sq. f~ o~ less $85.00 4 <br /> Each ad&flail 500 sq. ft. <br /> or pottic~ tbemof ~ $15.00 <br /> Limited Energy ~.~,' $~0.00 1 <br /> ]~ach ~Jaflt~d [-Iom¢ of Modtdar <br /> <br />Il. Services or Feeders (Does not Jnlcud¢ branch ci~citz, acc ~¢clJo~ D) <br /> Installation, Alterations or Relocation <br /> 200 ,.mira or tcs~. $50,00 <br /> 201 ~unF~ to 400 amps $60.00 -- <br /> 401 amps to 600 amps ~ $100.00 __ 2 <br /> 601 amps ~o 1000 amps -- $130,00 __ 2 <br /> Ow~, 1000 ~nps o~ vol~ $300.00 __ 2 <br /> Reconnect cndy $40.00 ....... 2 <br /> <br />C. Temporary $ervk-es/Pee0ers <br /> <br /> ~00 amps or le~s $35.00 ..... 2 <br /> 20t amps to 400 amp~ $40.00 <br /> 401 amps to 600 amFs $80.00 <br /> Over 600 stops or 1(~0 volts <br /> <br />J{). Branch Circuits <br /> <br /> a) ~1~ fee for branch ~muits wkh <br /> l~nmhase of servicg or,feeder fee <br /> <br /> Each bm~ch c~cu~t $2.00 <br /> <br /> b) The fe~ for bra~ck ch~ut~ without. <br /> 3~zrcha~e o¢ ~rvi~v.or feeder fe~ <br /> <br /> First branch circuit ~ $25,00 <br /> Bach additional brznch e/xvait $2,00 ..... <br /> <br /> E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump o~ ~figafion cirel~ $40.00 2 <br /> Each x~gn or outline llsht~lg $40.00 -- <br /> ~isnal c~euit(s) or a tlm~ted energy <br /> <br />E Each additional Inspection <br />over the alJowable in any of the <br />above, per ]~peefion ~ $35,00 <br /> <br />G. Minor installation Labels <br />Pack of 101abels @ $5,00 each $50.00 <br />¢o1~ only to electrical contractors) <br /> <br /> ( As ~qu2~ed by Build~8 Offic&l) <br /> <br />5. FEES <br /> Al, Enter total of fees from Sec, #4 <br /> $ <br /> A2, Add 5% surcharge (.05 x Al) $ <br /> Subtotal $ <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (s~. 3), if tequila $ <br /> C, l~ve~tlSatloa F~ (it' rcquftcd) $ <br /> D. R¢inspexalon Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $ <br /> <br />.... Re~i~ No. <br /> <br /> <br />