Laserfiche WebLink
ow% ONLr <br />Recetved by: <br />Da~e:._ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br />I 220 High 5n'eet NB <br /> Salem, Oregon 97301 <br /> Phone 588-5147 8:00 ~ - 4:3(~pm <br /> Code-A-Phone: 588-7904 <br /> pax: 5ss.7~ns SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />PI~RM/TS ARE NON-TRANSFI~RABLE AND NON-REFUNDABLE AND <br />EXFS(E IF WORK IS NOT STAR3qSD W1T~N lSO DAYS OB ISSUANCE <br />OR Il; WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />~ntracmg~Lic~seNo. ~bl~ ) ~ <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />MaiEag Address [ Phone <br />City/Ota~JZip <br /> <br />The inst allafiot~ is being made on prol~ny ! own'which is n~t int~lded for sale, <br /> <br />PLAN 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 />requi~l submission of lighting pOwer calculations, phns, <br />and specifications when required by the Oregon Structural <br />Specialty Co~e. Chapter 53. <br /> <br />MC 15-34 11/9] <br /> <br />Permit No, <br /> <br />Date: <br /> <br /> issued by: <br /> <br />4. FEE SCHEDULE (Complete and eater total ~n A 1 below) <br /> <br />A. Residential Per Unit <br /> <br /> $S5,0O -- 4 <br /> <br />....... $1S.00 <br /> $20,00 ..... <br /> <br />I~a~h Marmfd Home or Modular <br /> $40.00 <br /> <br />B. $er~ or F~e~ ~s not ~1~ branch civets, see s~c6~ D) <br /> <br /> lnstalhiUon, Alterations Or Relocation. <br /> <br /> ~01 amps to 400 0a~ps <br /> 401 mnps to 600 ~mps <br /> 601 amp~ to 100O amp~ ........ <br /> O~r 1000 ~aps or volts ....... <br /> <br /> 200 amps or less <br /> <br /> Ove,r,~6~O. amps or 1000 volts <br /> <br />a) The f~ for bra~0h <br /> <br />b) Th~ fee for bran& <br /> <br /> Signal clmuit(s) Or a limit~l ~ne~gy <br /> over the allowable i,n any of the <br /> P~.k d 10 hibels @ $5.00 each <br /> <br /> (As requlrsd by Building Official) <br /> <br /> FEES <br /> <br />A2. Add 5% surcharge (-05 x Al) <br /> <br /> ($~c. 3), if mqulrod <br />C. Inv~6ga6ort Fee (if mquit'eAI) <br />D. Rethspeefic~ F~e ($25.00) <br /> <br />50.00 <br />I60.00 <br />$100.00 <br />130,00 ........ 2 <br />300,00 2 <br />$40,00 2 <br /> <br />$35,00 <br />$40,0O <br />$80,00 <br /> <br />$35,00 <br /> $2,0O <br /> <br />$40,00 <br /> <br />Sao,oo <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />$ ~1,7° <br /> <br />$ <br />$~) ~-~ 0 <br /> <br />Receipt No. _,, <br /> <br /> <br />