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FOR. OFFICE. USE ONLY <br />] Received by: <br /> Date: <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> Salem, Oregon 97301 <br /> Phone $$$-5147 8:00 mm - 4:30pm <br /> FAX: ss.7 4s SITE #: 0 / 1993 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Di~fi~s <br /> <br />I'ERMI'I~ ARI~ NON -'II%~NSFERABLE AND NON-KEFUNDABLE SaND <br />E×P~B ~F WORK tS NOT STARTED WITHIN I80 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Ma~g Add,ss / ~ <br /> I <br /> .... <br /> <br />2B, FOR Oy~rNER INSTALLATIONS <br />Propuay Owner <br />Mail, s Add~s Phone <br />City/Stat~/Zip <br /> <br />The installation is being made on ptopafod I own whidl is ~a intended for sale, <br /> <br />Owner's 5ignatnre <br /> <br />3, PLAN REVIEW $EC'YION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B and submit two (2) sets of plans and specifica~ons 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 requited by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4, FEE SCHEDULE (Complete and entcr total in A l below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Item~ Cc~t (each) Sum <br /> <br />1060ssq, fi, or less $85.00 __ <br />Each at]difional 500 sq, ft. <br />or poaicu thereof $15.00 <br />Limked Erieergy $20,00 <br /> <br /> Dwelling Sen, lee or Feeder $40,00 __ <br /> <br />B. Services or Eceders (Do~a ~ot inlcudc branch c~rcuit9, seC ~ccfion D) <br /> <br /> Installation, Alterations or Relocation <br /> ~00 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 660 amps <br /> 601 amlpslto 1 fi00 amps <br /> Over 1000 amps or volt~ <br /> <br />C, 'rca~porary Services/Feeders <br /> <br /> 200 amps or less <br /> 201 amps to 400 amp¢; <br /> Over ~ amps or 1~0 ¥olt~ <br /> <br />D. Branch Cirena-q <br /> <br /> a) Th~ f~e for branch circuits with <br /> <br /> Each bianch <br /> <br /> b) Tee leg for branch circuta without <br /> r~areh a.~e of service or,cOder fcc <br /> <br /> Firat branch circuit <br /> Bach addlt/onal branch c~-euit <br /> <br />E. Mi~eellaneou$ (Service or Feeder Not Included) <br /> Each pump or in/gafion circle <br /> Each sign or outline l!~hting <br /> Signal cimuitO) or a I/to/ted energy <br /> panel, alteration or extemion <br /> <br />E Each additional Inspection <br /> over the Elowab~ in any of th~ <br /> above, per inspection <br /> <br />O. Minor Installation Lal~ls <br /> Pack of 10 laEcls @ $5.00 each <br /> (~old only to electrical contractors) <br /> <br />H. Other <br /> (As required by Building Official) <br /> <br /> ~50,00 <br /> 60,00 <br />$100,00 <br />$130.00 <br />$300,00 <br />$40,00 <br /> <br />$35,00 <br />$40,00 <br />$80,00 <br /> <br />$2,00 <br /> <br />$35.00 <br /> $~,oo <br /> <br />$40,00 __2 <br />$40.00 <br /> <br />$40.00 __2 <br /> <br />$35.00 <br /> <br />$5o.oo <br /> <br />5. FEES <br /> Al. Enter wial of fees from Sec, #4 <br /> A2, Add 5% surcharge (,05 x A 1) <br /> <br /> Subtotal <br /> <br /> B. Enter ~S%oflineA1 forPla~Review <br /> (Se~. 3), if r~ulrcd <br /> C, Inve~ligasiim Fee Of requill~d) <br /> D. Reinapectioo Fee ($2.5,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No.. ..... <br /> <br />$ <br /> <br /> <br />