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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High SUe. et NE <br /> Salem, Oxegon 97301 <br /> <br /> Phone 588-5147 $:00 am - 4;30pm <br /> Code-A-Ph~mc: 558-7904 <br /> FAX: 5SS-794S SiTE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> Cms St, <br /> <br />Description <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 150 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPg2qDED FOR 1 $0 DAYS, <br /> <br />2A, CONTEACTOR INSTALLATION ONLY <br /> <br /> p <br /> <br /> / <br />2B. FOR OWNER IN~ALLATIONS <br /> <br />Property Owner <br />Mailing Addres~ Phone <br />City/State/Zip <br /> <br />The imtallatlon Js biting made on property I own which is not intended for sale, <br /> <br />3. PI.AN REVZEW 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 Stractttral <br />Specialty Code, Chapter 53. <br /> <br />4, FEE SCHEDULE (Co~'~lete and enter total in A1 below) <br /> <br />A, Residential Per Unit <br /> Service Included: <br /> <br />$85,00 -- 4 <br /> <br />I000 sq. ft. or hiss <br />l~ach additional 500 sq. f. <br />Limit~ P°~nergydE $1 S ,00 <br /> $20,00 <br /> <br /> Dwelllng Service or Feeder $40.00 <br /> <br /> 5O 00 <br /> 200 amps or less $ $60]00 <br /> 201 amps to 400 amps <br /> 401 arnva to 600 amps $100,00 <br /> 601 am to 1000 amps $130.00 <br /> Over I~ amps or volts <br /> $300,ec <br /> Reamne~t only ~-' $40,00 <br />C. Temporary Services/Feeders <br /> <br /> 200 amps or less $35,00 <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps $80,00 <br /> Over 600 amps or IO(X) volts <br /> <br />D. Beanch C~rcufts <br /> <br /> a) The fee for bra~ch Cimt~ts Mth <br /> <br /> Each branch circuit $9.00 <br /> b) Thc fe~ for branch clmuts <br /> <br /> above, per Inspection $35,00 <br /> Pack of I0 lab61s @ $5,00 each $50.00 <br /> <br /> (As required by Bu#ding Official) <br /> <br /> EeS <br />Al. Enter total of ~ees from Sec, g4 <br />A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of llne A 1 for Plan Review <br /> (Sec, 3), if required <br />C, Investigationgce (ff required) <br />D. Reinspccnon Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br />MC 15-34 11/91 <br /> <br /> <br />