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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> ELECTRICAL PERMIT A,PPLICATION <br />...... please complete all Sections, ! through 5 <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 ~n - 4:30pm <br />Code-A-Phone: 588-7904 <br />FAX: 55s-794s SITE #: <br /> <br /> C~q , ~'LL~.. ~Ck~r.~_ ~sued by: <br /> <br />1. lA, CATION OF iNSTALLATION <br /> <br />JobAddmaa <br /> <br />PERM fI'~ ARE NON-TRANSFeRABLE AND NON-REFUNDABLE AND <br /> / <br />RXPiRE IF WORK I$ NOT STARTED WIDIIN 1 $0 DAYS OF ISSUANCE <br />OR 1F WORK IS SUSPENDED FOR 1 g0 DAYS. <br /> <br />2A, CONTRACTOR INgYAI,LATION ONLY <br /> <br />~ntractorsBoardR~g,~o, S/i ~ / <br /> <br />%B. FOR O~q~IER INS;I'ALLATION$ <br /> <br />Ma/Jing Address Phone <br />City/StatclTjp <br /> <br />The ins~alla6on Rs '~ing ma&: on pro.ny l own which is not intended for sale, <br /> <br />Owner% Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br /> We will provide plan review serried it-you complete Section <br /> 50 and submit two (2) sets of plans and specifications with <br /> this application, <br /> <br />This optional plan review program does not suspend thc <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />~4, FEE SCHEDULE (Complet~ and enter total in A1 below) <br /> <br /> A. Residential Per UnitNumber o1' Inspections [~v pc.nit allowed q <br /> Service Included: Iteras Cost (each) Sum/ <br /> 1000 sq. fi o~ Ess $85.00 __ 4 <br /> Each a(Idi6ona1500 s~. fi, <br /> o¢ tx~tic~ thereof $16.00 <br /> t ,imi~ ~Y ' <br /> Bach Manufd Home or Modula~ <br /> Dwelling Sea'dm or Feeder .... $40,00 -- 2 <br /> <br />B. S.rvto~s or Feeders (Does not <br /> Installation, Alterations or Relocation <br /> <br /> 200.-,rips or less ~ $50,00 <br /> 201 ~p~ to 400 amps $60,00 <br /> 401 aml~ to 600 amps $100.00 <br /> 601 amp~ to 1000 amps $1ao,0o <br /> Over 1o~o amps or vohs $800,00 <br /> Reoonnect only $40.00 <br /> <br />C. Temporary aervleesA%~lers <br />Installation, AIteratlon, Or Rctocatinn <br />200 amps or less $85.00 <br /> 201 amps to 400 am~s ~ $40.00 <br /> 401 ~nps to 600 aml~ $60.00 <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Clrenits <br /> New~ Alla'atlon, or Extension Per Panel <br /> <br /> a) The fee for branch d~cuit ~ ~h <br /> <br /> Each branch cirmli[ $2.0e) <br /> <br /> b) The fee for bratlch d?lgl~$ ~vilhout <br /> mlmhase of ~rvice or fe~der fee <br /> <br /> Fire branch elreuJt $35.00 <br /> Bach additional branch citeui~ ~ $2.00 <br /> <br />R, Miscellan~,u$ (Service or Feeder Not Inclu fled) <br /> 'Each lallnp or irrigation circle $40.00 <br /> Each slgn or omlhl¢ lighting __~ $40.00 <br /> <br /> panel, almratinn or extension ..,~ $40,00 <br /> <br />E Each additional inspection ' ~' <br />over the allowable in any of the <br />abo,~, pet Im[mcQon $35.00 <br /> <br /> Pack of tO Iabel~ @ $5D0 each ~ $50.00 <br /> (sold only ~o Mectrica[ co~r~ctorr) <br /> <br /> (A.* r~quired by B~ilding Officlal) <br /> <br />5. FEES <br />Al. Enter tetalof fee~ froinSec.~4 $ t.~, ~ <br />A2. Add 5% stlrcharge (,05 x A 1) $, ~ '~' <br /> <br /> Subtolal $ 7~ <br /> <br /> B. Enter ~% of ~ne A1 for lqan Review <br /> $__ <br /> C, Inv~tigafion Fee (ff ~u~d) $~ <br /> D, R~s~ Fee ~.~) $ ,, <br /> ~TAL AMO~I' DUB~ [.~/ / <br /> Re~i~ No, <br /> <br /> <br />