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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTy BUILDING INSPE~(~ ~ ~ ff ~t/~ <br /> , 220 High Street NE <br /> Salem, Oregon97301 F~ I 0 1994 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Codc-A-l~hone: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />SITE #: Mtl~!r~* .... Permit No. <br />Date: UlLUIg/(3 iN.qp~OTiO <br />Issued by: <br /> <br />1. LOCATION OFIN~ALLATION <br /> <br />,o Add*,, [ooq% <br /> <br />PERMfI~ ARE NON-'I'RANSFERABLE AND NON.ILEFUNDAB LE AND <br />EXPIRE It: WORK IS NOT STARTED WrH-ll3[ 180 DAYS OF ISSUANCE <br />OR IE WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSVFALLATION ONLY <br /> <br />'~B, FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br />Mailing Address I Phone <br />City/St atef)~ip <br /> <br />Thc installation is being tv~ad4 on propeiiy I own which iS not illt¢flded for sale, <br /> <br />Owner's Signature ........ <br /> <br />3. I'LAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets et' 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 thc Oregon Structural <br />Specialty C(xtc, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number {ff Inspections <br /> per <br /> permit <br /> A. Residential Per Unit ] <br /> Service Included: Items Cost (each) Stl{~ <br /> / <br /> <br /> 10{X) ~q. E. or les~ $85,00 ........... <br /> Each additional 500 sq, fl, <br /> or portic~ thereof $15.00 <br /> Limi~d Energy $20.00 '~¢='-~c- <br /> Each Manufd Home oe ,Modeler <br /> Dwellit~g Service or Feeder $40,00 -- 2 <br /> <br />B. Services or Feeders (Does not inleude branch c,refills, see section D) <br /> Installation, AlteraSons or Relocation <br /> 50.00 2 <br /> 200 amps or less $ $60,00 <br /> 201 amps to 400 a~ps <br /> 401 amps lo 600 amps $~00.00 ~ <br /> 601 amps to 1000 amps $IS0,00 2 <br /> Over 1000 amps or volts $300,00 __ 2 <br /> Reconnect only $40,00 __ 2 <br /> <br /> 200 amps or less $35.00 __ 2 <br /> 20I amps to 400 amps $40,00 -- 2 <br /> 401 ~'nps to 600 amps $80.00 -- 2 <br /> Over 600 amps or 1000 volts <br /> <br /> a) The fee for branch cAmnits with <br /> purchase of ~crvte¢ .oL feeder fee <br /> <br /> Each branch eimuit $2.00 <br /> <br /> b) Thc fee for branch circuts without <br /> pumhasc of servi~~ 9r ~'~¢der fee <br /> <br /> First branch cimttil $38,00 <br /> Bach additional branch clrcuJt ..... $2.00 __ <br /> <br />E, Miscellaneous (Service or Feeder Not Included) <br />Each pump or irrigation circle $40.00 ..... 2 <br />Each ~ign or oo0.ine lighting $40.00 -- 2 <br /> <br />E Each additional Inspection <br /> <br /> above, per h~spechon $35.00 <br /> <br />G, Minor Installation Label~ <br />Pack of 10 labels @ $5.00 each $50,00 <br />(sold only to electrical conlroctor$) <br /> <br />H. Other <br /> (As required by BuiMing Official) <br /> <br />5. FEES <br /> A I. Enter ~otal of fees from Sec. #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of llne A1 for Plau Review <br /> (Sec, 3). il mqulred <br /> C, hlvestigationFee (ff mquived) <br /> D, Reinspection Fee ($25.00) <br /> <br /> I'OTA L AMOUNW DUE <br /> <br /> Receipt No. . .... <br /> <br /> <br />