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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> 1. LOCATION OFINSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> ~ Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 SITE #2 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />PermltNo. <br /> <br />PERMITS ARE NON -'IRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WfI'HIN 180 DAYS OF ISSUANCE <br />OR it; WORE IS SUSPENDED FOR I80 DAYS. <br /> <br />;gA, CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address t~. ~o ~ID-X 6 "~ I <br />Pr~,~rlY Owner ~ O~ ~ Phone <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mailing Address Phone <br /> <br />City/Stat@Zip <br /> <br />Thc inst dilation i$ being made on property I own w~eh is not intended for gale. <br />lease, or rant. <br /> <br />Ownc?s Sig~atl re .,, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />513 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 requirod by the Oregon Structural <br />Spccia/ty Code, Chapter 53, <br /> <br />MC 15-34 11/91 <br /> <br />4. PEE SCHEDULE (Complete and enter total in A l below) <br /> Number @ Inspections per permit al|owed .--] <br /> <br />A, <br /> Re_~idential <br /> Per <br /> Unit <br /> Service Included: Items Coat (each) St~mi <br /> <br /> 1,000 sq, IL or less $35.00 __ 4 <br /> Each additional 500 sq, fi, <br /> or ponie~ thereof $15.00 ........ <br /> Limited Enc $~0,00 1 <br /> Each Manu~Iomc or Modular' <br /> Dwelling Set,Ace or Feeder $40.00 __ ~ <br /> <br />B, Services or Feeders (Docs not inleude beap¢h Orc~dts, sec section D) <br /> Installation, Alterations or Reloeatiun <br /> <br /> 200 amps or less <br /> 201 amps m 400 amps <br /> 401 amps to 600 amps <br /> 601 amlp~to 1000 amps <br /> Over 1000 amps or volts <br /> Reco~xae~ only <br /> <br />C, Temporary Services/FeederS <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amraps s to 600 amps <br /> Over 600 amps or 1000 volts <br /> <br /> D, Branch Circuits <br /> <br /> a) Th~ fee for branch circuits ~ <br /> pumhas¢ of ~erv~Ce or feeder fee <br /> <br /> Each branch circuit <br /> <br /> b) The fee for branch cimuts ~ <br /> purchase of service 9t ;f~0~ fee <br /> First branch circuit [ <br /> Each addk]ona! branch circuit t~ <br />E. Miscellaneous (Service or Feeder Nut Ineludeil) <br /> Each pump or irrigation ekele <br /> Each sign or outfine lJ, ghting __ <br /> Signal ¢imuk(g) or a limited energy <br /> <br />E. Each additional Inspection <br /> over the allowabl~ in any of the <br /> above, per ~nspeet~on <br /> <br />Gt, Minor Installation Labels <br /> Pack of 10 labels @ ,$5.00 each <br /> (sold only to electrical ¢ontraclora') <br /> <br />It. 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 />$3S.00 ~-'~- <br /> SZO0 ~ <br /> <br />$40,00 __2 <br />$40,00 --, 2 <br /> <br />$40.00 --2 <br /> <br />$35.00 <br /> <br />SS0.00 <br /> <br />5. FEES <br /> A 1, Enter total of fees l¥om Sec, #4 <br /> 42. Add $% surcharge (,05 x Al) <br /> <br /> Subto[al <br /> <br /> g. Enter 25% ol'line A 1 for Plan Review <br /> (Sec. 3), if' mq ujff,:d <br /> C, InvestigationFe¢ (ff reqtfired) <br /> D. Relnspeclion Pee ($25.00) <br /> <br /> 3/,)'I'AL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br /> <br />