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FOR OFFICE USE ONLY <br />Received by~ <br />Date: <br /> <br />MARION COUNTY: BUILDING INSPECTION <br /> <br /> ' 220 High Street I~ <br /> Salem, Oregon 97301 <br /> <br />Phone 585-5147 8:00 mn - 4:3GI'an <br />Code-A-Phone: 588-79~4 <br /> FAX: 588-7948 <br /> <br />lELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5....] <br /> <br /> 1, LOCATION OFINSTALLATION <br /> <br />SITE #: JA~ 0 7 ~i'~t No. <br />Date: IVIARION COUNTY <br /> BUILDING INSPECTION <br />ssued by: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXI'IRE IF WORK i$ NOT STARTED WITI-I1N 180 DAYS OF ISSUkN'CE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRA~I'OR INSTALLATION ONLY <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />Thc installation ia being made on property I own which is not j. ntended for sale~ <br />lease, or rent. <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SEC~I'ION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets o£ 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 II/91 <br /> <br />4. FI~E SCHEDULE (Complete and eater total in Al below) <br /> <br />A, Resldentl~l Per Unit <br /> Service Included: <br /> <br />1000 sq. fl. or less <br />Each additional 500 sq. ff. <br /> or portlcn~ the~of <br />Limited Energy <br /> <br />Number of lnspoe¢lons per permit allow~ <br /> <br /> Itcnna "Coat(each) <br /> $85,00 ,, 4 <br /> <br /> $15.00 .~_~.~. <br /> __ $20,00 <br /> <br />Each Mannfd Home or Madalar <br />Dwelling Service or Fe~ler $40.00 <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to ~ amps <br /> 601 amp~ Io 1000 amps <br /> <br /> R~nnrJet only <br /> <br />C. Teml~orary Serviee~/Foeders <br /> <br /> 201 ~mps to 400 amps <br /> <br /> Ovo[6,00 amps or 1000 volt-q <br /> <br />D. Branch Circuits <br /> New, AIt~atlon, or ExtenSion Per Panel <br /> <br /> a) The fee for branch <br /> <br /> Each branch circuit <br /> <br /> b) The fee roi' ~mnch c/rcuts withop[ <br /> parcha~c of service pt feeder fcc <br /> <br /> First branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> <br /> Signal eircuit(O or a llm/~eg every <br /> <br /> over the allowable in any of the <br /> above, per <br /> <br /> Pack of 10 lal~ls @ $5.00 <br /> <br /> ( A~ required by Building Official) <br /> <br /> ~60,00 <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 /> $2,00 <br /> <br />$40.00 ....... 2 <br />$40.00 __2 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> A 1. Enter total of fee~ from Sec. #4 <br /> A2, Add 5% aurcharge (,05 X A l ) <br /> <br /> Subtolal <br /> <br /> B. Ent~r25%ofl~neA1 for PlanReview <br /> (Sec. 3), if required <br /> C. InvestigatlonPe¢ (if required) <br /> D. Reinsl>e. eQoo Fee ($25.00) <br /> <br /> 'IDTAL AMOUNT DUE <br /> <br /> Receitx No. <br /> <br /> <br />