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Received, ~y~ I
<br />
<br />ELECTRICAL PERMIT APPLICATION
<br />Please complete all Sections, 1 through 5
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />
<br /> SITE #:
<br />
<br /> Date:
<br />
<br /> Issued by:
<br />
<br /> 220 High Stxeet NE
<br /> Salem, Oregon 97301
<br />
<br />Phone 588-5147 8:00 am - 4:30pm
<br />Code,-A-Phon~: 588-7904
<br /> FAX: 588-7948
<br />
<br />1. LOCATION OF INSTALLATION
<br />
<br />c~ f)/D~O~, ~R ]c~sst, ~,,9~¢'Z
<br />
<br />PEKMIT~ ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND
<br />EXPIRE IF WORK IS NOT STARTED W1TH]N IS0 DAYS OF ISSUANCE
<br />OR IF WORK IS SUSPENDED FOR I$0 DAYS,
<br />
<br />2A. CONTRACTOR INSTALLATION ONLY
<br />
<br />Phone
<br />
<br />Mailing Address
<br />Property Owner [Phone
<br />
<br />Contractor's Board Reg. No, ] .Tob No.
<br />Signatu~ of Sup~fvJ$if~g El~ela'ician
<br />
<br />Sup~vhofs L~ns¢ No.
<br />
<br />2B. FOR OWNER INSTALLATIONS
<br />
<br />IPhoncNo, ,,i
<br />
<br />Propurty Owncr
<br />
<br />Ma~ing Addte~ ~t
<br />
<br />City/Star, TAp
<br />
<br />Thc instalhtlon is ~ing made on ploI~tsy I own which is not Mtandcd for sale,
<br />
<br />Owner's Signature . ~ .......
<br />
<br />3, PI,AN 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 Oregon Structural
<br />Specialty Code, Chapter 53.
<br />
<br />,E
<br />
<br />d. FEE SCHEDULE (Complete and enter total in A I below)
<br /> Number ~ Inspections per permit allowed ---]
<br />A.
<br /> Resldentlel
<br /> Per
<br /> Unit
<br /> /
<br /> Service Included: Itcans C~t (each) Sum/
<br />
<br /> 1000 s~ fL or less $85.00 4
<br /> Each add~t~nla1500 SCl, ~.
<br /> o~ ixmion thet~f $15.00 __
<br /> Limited Energy $20,00 -- 1
<br /> Each Manafd Iqom¢ or Modular
<br /> Dwe]lin$ Scrv~ec or Feade~ $40,00 -- 2
<br />
<br /> n. Ser~I¢~ er ~'eaders (Do~s not inlcudc branch cimalts, scc scction D)
<br /> Installation, Alterations or Relocation I $S0.00
<br /> 200 mnps or lass
<br /> 201 araps to 400 araps $60.00 .............
<br /> 401 amps to 600 amps $~ 00.00
<br /> 601 amps to 1000 am~ $~80.~0 __
<br /> Owr 1000 amps or volts $S00~00
<br /> Reco~mec~ only SaO.00 2
<br />
<br />C, Temporary Services/Feeders
<br />Installaaon, Alteration, ot Relocation
<br />200 craps or less $85.00 2
<br />201 amps to 400 amps $40.00 __ 2
<br />401 amps to 600 amps $80.00
<br />Over 600 mup~ or 1000 volts
<br />
<br />D. Branch Circuits
<br /> New, Alteration, or ExtenSion Per Panel
<br />
<br /> a) The f~ fo~ branch ¢i~uits with
<br /> nnrcha~ of service ot fg,adet fee
<br />
<br /> Each branch circult $2,00 ,,,
<br />
<br /> b)The fee for branch clrcuta without
<br /> purchase of scndca or
<br />
<br /> First bta~ch altcmit $S500
<br /> Each additional brmch alrcult $2,00
<br />
<br />E. Misceltantn~us (Service or Feeder Not Included)
<br /> Each pump cc irrigation ciral~ $~0,00
<br /> Each sign or ou~te llgMing __ $~0:00 ,
<br /> Signal cJ.w. ult(s ) or a IimiteA energy
<br /> panel, alteration or extension $40.00 __ 2
<br />
<br />E Each additional inspection
<br />over the allowable in any of thc
<br />above, pet Inspection $35,00
<br />
<br />0. Minor Installation J~abel$
<br />Pack of l0 labels @ $5.00 each $S0.00
<br />(sold onty to electrical contractors)
<br />H. Other
<br />( As required by Building Official)
<br />
<br /> t .......
<br />5. FEES
<br /> Al, Enter total of fc~eS from Sec, #4 ' $ ~
<br /> A~. Add 5% s~rcha~a (.05 x A 1)
<br /> $
<br />
<br /> Subtotal
<br />
<br /> B. Enter 25% of linc Al for Plan Review
<br /> (S~c. 3), if r~qulrad $
<br /> C. InvestigationFe~ (ff mqulmd) $
<br /> D, ' ~ t~on F 25.00) ,
<br />
<br />MC 15-34 1,1191
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