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IFOR OFFICE USE ONLY MARION COUNTY BUILDING INSPECTION <br />Received by: 220~igh S~t NE <br /> Date: .. ~ , 'Salem, Oregon9730L. <br /> <br /> P~ FAX: 555-7945 t2~ : <br />IELECTRiCALPERMITAPPLICATION Dr ~t~¥ 2 4 1994 Date:_ <br /> Please complete all Sections, 1 through 5 / ' - ...... Issued b- <br /> ................. / MARION t;uul~l~ <br /> <br />BUILDING <br /> <br />PF21,M1TS ARE NON.TRAI~FERABLE AND NON.REFUNDABLE AND I <br />EXERE IF WORK I$ NOT STARTED wIrl-rlN 180 DAYS OF I~SUANCE <br /> I <br />OR IF WORK IS SUSPENDED FOR. 1 $0 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Elcadcal C~'m'~ctorC ~_ ,- , , . ] Phone'Z.~-~-G~-;:' ~- <br /> <br />Contractor's Board Reg, No, ~1~ ! ( (~ I I Job No, <br /> <br />SUl~rvis°rsLicenseN°' -~¢'y '.t ~-- IPh~peNo <br />~B. FOR OWNER INSTALLATIONS <br />Prol~r[¥ Owner <br /> <br />Mailing Address [ Phone <br />Chy/~tatcf~ip <br /> <br />Tho inst~llafion is being made on propurty I own which is nCq intended for sale, <br /> <br />Own&s S~gnamm ... , <br />3. 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 doe~ not suspend the <br /> required submission of lighting powor calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapt~ 53. <br /> <br />MC 15-34 11/91 <br /> <br />REC'D <br /> <br /> 200 amps or less <br /> 201 ami~ to 400 ttmps <br /> 401 ~mps to 600 amps <br /> (~01 am~psltO 1000 maps <br /> Owt 1000 amps or volts <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or lcss <br /> 201 amps to 400 <br /> 401 amps to 600 amps <br /> Ov,r 600 amps or 1000 volts <br /> <br />D. Branch Circalm <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch circuits wkh <br /> vureha*e o~e~d~ or <br /> <br /> Each bnmch circuit <br /> <br /> b) Th~ fee for branch circut* ~ <br /> <br /> Each additional branch ~muit <br /> <br />E. Miscellaneous (Service or Peeder Not Inc oded) <br /> Each pump or iffigatim eJrcl¢ <br /> Each sign or outime lighting <br /> Signal uircuit(s) or a limkedcne~y <br /> <br />F, F..aeh a~dlnonal Inspection <br /> ever the allowable in any of th~ <br /> <br />G. Minor Installation Labels <br /> Pack of 10 lal~ls @ $5.00 each __ <br /> (sold only to el~ctr-~¢ol ¢o~tractor~) <br /> <br />H. Other <br /> (As r~qulred by Bt~ilding Official) <br /> <br />S. FEES <br /> Al, P~ntcr total of fe~s frOm Sc¢- #4 <br /> A2, Add 5% surcha~g~ 605 x Al) <br /> <br /> Subrotal <br /> <br /> B. lgn~er 25% of lin~ At tot Plan Review <br /> ($~c. 3), ff <br /> C. Investigation [~ee (if required) <br /> D. Reiml~:tic~ Fc~ ($25.00) <br /> <br /> TOTALAMOUNT DUB <br /> <br /> ~50,00 ........ 2 <br /> 6O.00 <br />$100.00 -- <br />$130.00 -- 2 <br />$300.00 <br /> $40.00 <br /> <br />$35.00 <br />$40.00 <br />$80.00 <br /> <br />... Receil~ No, <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2,6O <br /> <br />40,6o <br />40.00 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50,6O <br /> <br />:?ECT!O~ ............ <br /> 4. FEE SCHEDULE (Complete and eater tOtalin A1 below) <br /> Nomber of Inspections pm- permit allowed <br /> A. Residential Per Unit l <br /> Secvke In¢loded: Ires'ns Cost (each) Sum/ <br /> <br /> I(X)0 sq. R. or l~s $~5,00 . 4 <br /> Bach additional 500 sq. ft, <br /> or porfian thereof $15.00 <br /> Limited Energy [ $20.00 -- 1 <br /> Each Mannfd Home or M~luiar <br /> Dwcnlng SelMo~ or Feeder $40.00 2 <br /> <br /> B. Ser*lo~ ot+ Feeders {Do~, not ~'flcnd~ branch circuits, sec ~ectlon D) <br /> lnstMIstion, Alterations or Relocation <br /> <br /> <br />