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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588.5147 8:00 am - 4:30pm <br />Cede-A-Pbgc: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION" <br />Please complete ...... afl Sections, I throug~ , <br /> <br /> gO <br /> <br />EXP~E IF WO~ IS NOT STAKi'ED Wi'rH~ 180 DAYS OF I$~U~CE <br />OR IF WO~ IS SUSP~DED FOR 180 DAYS. <br /> <br />lA. co~rRA~Og INhALaTION ONLY <br /> <br />OWNER INSTALLATIONS <br /> <br />Property Owner <br />Mailing Address Pbcrae <br />Oty/Stat~/Zip <br /> <br />The installafiotl is bdilag made on property I own which is nix intended for sale, <br /> <br />3. PLAN REVIEW SigCTION <br /> <br />Wu will pmvi~ plan review service if you complete Section <br />5B and submit two (2) ~ets of 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 /> SITE #: <br /> MARION C0UNIY <br /> Dat°~uI~)ING <br /> Issued by: <br /> <br />A. <br /> R~dential <br /> Unit <br /> S~icc Included: It~ Coal (c~h} Sum <br /> <br /> ~ ~ thereof $ ~ 5,00 <br /> ~ ~e~ $~.00 1 <br /> E~h Manufd ~ome or M~ar <br /> Dw~n~ Se~ or F~d= $40.00 ~ 2 <br /> <br />B. Ser~ or ~eeders (D~s not ~leude Nanch circt~ts, see seo~on D) <br /> <br />MC 15-34 11/91 <br /> <br /> InstallaUon, AIt~aUons o~ Relocation <br /> 200 aml~ or less $50.00 <br /> 201 amps to 400 amps $60,00 <br /> ~01 amps to 600 amps $100.00 <br /> 601 amps to 1000 aml~ $130.00 <br /> Over 1000 amps or volts $300.00 <br /> Reconne¢[ c~ly $40.00 <br /> <br />C. Temporary Servlces/Feedees <br />Ins[a0afion, Alteration, or RcloeaUon <br />200 amps or less $35,00 <br />201 amps m 400 am~ $40.00 <br />401 amps to 600 mmps $80.00 <br />Ove~ 600 maps or 100) volts <br />sec "B' above <br /> <br />D. Branch Circuits <br /> New, Alteeatlon~ Or Extension Per Panel <br /> <br /> a) The fe~ for ~anch dr~mlts ~ <br /> purchase of service or feeder fee <br /> <br /> -Each bnmch circuit $2,00 <br /> <br /> b)The fee for branch cireuta without <br /> purchase of service or few. let <br /> <br /> First branch circuit $35.00 <br /> ltae.,h additional branch circdit $2,00 <br /> <br />E. Miscellaneous (Servlee or Feeder Not Included) <br /> Each pump or irrigation circle $40.00 <br /> Each sign or ou0iIle lightstg -- $40,00 <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension ~ $40 <br /> <br />ih'. Each additional Inspeetlon <br />over the allowable in any of the <br />above, per Insl~ction $85.00 <br /> <br />G-. Minor Installation Labels <br /> Pack of 10 labels @ ~.00 each <br /> (sold oMy to electrical <br /> <br />H. Other <br /> ( As mqu&~d by Building Official) <br /> <br /> FEES <br />Al, Enter trial of fees from Sec. #4 <br />A2, Add 5% surcharge (.05 x A 1 ) <br /> <br /> Subtotal <br /> <br />B. Enter ~5% of llne A1 for Plan Review <br /> (Sec, 3), if required <br />C, hiv~tigationFee (ff required) <br />D- Reinsp*elim Fee ($2.5,00) <br /> <br />'rOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />