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FOR. OFFICE USE ONLY <br />Rece,ved ~: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High S~rc~t NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 58~-5147 8:00 ~n - 4:30pm <br /> Code~A-Phone: 5SS-7904 <br /> FAX: 555-794S <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Date: //- /~- q ,~' <br /> <br />Issued by: <br /> <br />L LO,AriaN OF INSTALLATION <br /> <br />PEI~flTS ARE NON-TRANSE~P. ABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED ~rfrH]N 150 DAYS OF iSSUANCE <br />OR LF WOP. K IS SUSPI~DED FOR I SO DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Property Owner <br /> <br />ContractOr'S Lie,~mse No. <br /> <br />~tractor'~ Board Reg. No. <br /> <br />Sigr~u~ of SUl~nfislng <br /> <br />r- ,,, <br /> <br />Su~rvhor's Ucensc No. ) ~ Ph~e N~. <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Pml~ty Owner <br />Mal]ing Add.ss Phone <br />Cityf&attf~ip <br /> <br />Tbe inst~lintlon is berg ma& on pwpetty I OWn which is nc{ int~dad for sale, <br /> <br />We wiU pwvide plan review service if you complc~ S~fion <br />5B and submit ~o (2) se~ of phn8 ~d s~fions wi~ <br />this a~licafion. <br /> <br /> This optional plan review program does not suspend [he <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 H/91 <br /> <br />4. FEE SCHEDULE (Complete and cnO~r total in A1 be. low) <br /> Number of Inspections pm- permit allow~l ---] <br />A. <br /> Re~ldenUa[ <br /> Per <br /> Unit <br /> ] <br /> Service Included: Item~ Co~t (each) ~%ml <br /> <br /> 1000 sq. f~ or 1~s $85.00 4 <br /> Each additional 500 $q. fi- <br /> orarpmrfien thereof $15.00 <br /> Limil~ Enemy $ ~0.00 __ 1 <br /> Each MamWd Home or Modular <br /> Dwelling Servi~ or Fe.~dex $40.00 -- 2 <br /> <br />IL Ser,~te~ Or Feeders (I)o~s not hzlcude br~nch ~iwdiia. ~ scctinn D) <br /> lnMallatloo~ Alterations or Rdo~aUon <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 601 amps to 1000 amps <br /> Over 1000 ~ps orvolt$ <br /> Reo;,nneet ~ly <br /> <br />C, Temporary Servlces/Feedees <br /> ]{nsinilaflon, Alteration, or Rdoeation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> over ~ ~mv: or 1~0 volt~ <br /> <br /> a) Thc fcc for branch d~-uits <br /> <br /> ~ach b~a~ch <br /> <br /> b) Th~ fe~ for bra~ch c~rcats <br /> ourchase of sewlce or (e.e. de~ fcc <br /> <br /> First breach circoa <br /> <br /> Each sign or outiln¢ .lighting <br /> <br /> Pack of l0 labels @ $5,00 ;ach <br /> (~old only to electrical co,rectors) <br /> <br />II. Other <br /> ( As rtqtgred by Building Offwia0 <br /> <br />s. fi i S <br /> Al. Enter tc~al of fees from Se~. #4 <br /> A2. Add 5% surcharg~ (.05 x Al) <br /> <br /> Sub~ <br /> <br /> B. Enter ~% of llne A1 for ~ Review <br /> ~. ~). if ~q~r~ <br /> <br /> ~TAL ~OU~ DUE <br /> <br /> ~i~ No, ,, <br /> <br />$100,00 2 <br />$130.00 2 <br />$300,00 2 <br />$40,00 2 <br /> <br />$3S,00 2 <br />$40.00 2 <br />$8o.oo 2 <br /> <br />$2,00 <br /> <br />$8,5.00 <br /> $2,O0 <br /> <br /> 40,00 __ 2 <br /> 40.00 2 <br /> <br />$40.00 __ 2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />$ <br />$, <br />$ <br /> <br /> <br />