Laserfiche WebLink
[Fo. °%iC ONLY <br />/ Received by:. <br />Date: <br /> <br />I <br /> 1. LOCATION OF INSTALLATION <br /> <br /> MARION CO~UNTy BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88-5147 8:00 am - 4:30pm <br /> Code-A-l~o~: 558-7904 <br /> tAX: ~SS-?~S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION [ Date: <br />Please complete all Sections, i through 5I Issued by: <br /> <br />Permit No, <br /> <br />PERMrPS ARE NON-TRANSFERABLE AND NON-I~FUNDABLE AND <br />EXPIRE iF WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDBD FOR IS0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Propuny Owner <br />Ma~g Add.ss I Phone <br />City/State/Zip <br /> <br />The installation is being made on propu~y I own which is no{ intended for sale, <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 />MC 15-34 HI91 <br /> <br />4, FEE SCHEDULE (Complete and cater to,-I in A 1 below) <br /> <br />A. Residential Per Unit <br /> Service Included: <br /> <br /> 10(X) sq. ft. orlcss <br />Each atlflitinnal SOO sq. ft, <br /> or l~ninn the~of <br /> <br />$85,00 , , 4 <br />$15.00 <br /> <br />Limited Energy $20.00 <br />Each M~nufd Home or Modular <br />Dwelling Scrvic~ or Feeder $40.00 <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 601amtpsl to 1000 ~rnps <br /> Over 1000 amps or volts <br /> Reconnect c~ly <br /> <br />C, Temporary Servlces/Fcederz <br /> installation, Alteration; or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 ,maps to 600 am <br /> <br /> a) The fee for bran ch 6r~oi[s wlth <br /> vurchaae of service ca' fa .edit.fee <br /> <br /> Each branch circuit <br /> <br /> b) The fee for branch circats w~thout <br /> purchas~ 9f .s.e~ee or feeder fee <br /> <br /> First branch circuit <br /> Each additional branch <br /> <br />]E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irfi gat/oxl ¢,ir~le <br /> Each sign or outline lighting <br /> Signal circuit(s} or a llRtited <br /> <br /> above, per I~spactlon <br /> <br /> Pack of tO labels @ $5,00 ~ach <br /> <br />H. Other <br /> ( As mqtdred by Building Offlcia0 <br /> <br /> ~$0.00 .......... 2 <br /> 60,00 2 <br />$~00,00 <br />$130,00 <br />$300.00 <br /> $40.00 __2 <br /> <br />$35.00 <br />$40.00 <br />$80.00 <br /> <br />$2,00 <br /> <br />$35.00 <br /> <br />$40,00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$3500 <br /> <br />$50.00 __ <br /> <br />5. FEES <br /> A 1, Enter total of fees from Sec, #4 <br /> A2, Add 5% surcharge (.05 xA1) <br /> <br /> Subtoml <br /> <br /> B- Enter 25 % of linc A 1 for Plan Review <br /> (Sec, 3), if ~equired <br /> C. investigation Fee (ff required) <br /> D. Relnspuction Fee ($2.5,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />Receipt No. <br /> <br /> <br />