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FOR OFFICE USE ONLY
<br />Received by:
<br />Date:
<br />
<br />MARION COUNTY ~UILDING
<br /> ' 220 High Street NE
<br /> salem, Oregon 97301
<br />
<br /> Ph~e 588-51~7 8:~ ~ - 4:3~
<br />
<br /> F~: 588-7948
<br />
<br /> I
<br />ELECTRICAL PERMIT APPLICATION "
<br />I
<br />Please complete all Sections, I through 5
<br /> I
<br />
<br />1, LOCATION OF INSTALLATION
<br />
<br />;obAdd~ss 20256 Grim Road NE
<br />Cky Aurora ]Cro~sSt Boones Ferry Road
<br />Olrec~n~ Baseba,l,,1 field south of North Marion
<br />
<br />MiRh School,,,,building
<br /> Dcs¢fip6on Service and scoreboard.
<br />
<br />P~RMI3S ARE NON-3RANSE~RABLE AND NON-ILEFUNDABI~ AND
<br />F~ X'n~RE IF WORK IS NOT STARTED wrTI.IE¥ 180 DAYS OF ISSU/M~CE
<br />OR IF WORK ~S SUSPENDED FOP. 180 DAYS,
<br />
<br />%A. COlqrRNCTOR INgTALLATION ONLY
<br />ElectrlcalComtactor JR Electric
<br />
<br />I?h<e981-3913
<br />
<br />MaillosAddmsspo BOX 266, Hubbard OR 97032
<br />Pr°peayOwn~orth Marion Schools [Ph°ne678-5835
<br />Commemf$ L~cease No. 24-205C
<br />
<br />co~ua¢oes Board Keg, No. 50829
<br />Signature of Su~rvls~ng El, cctrloian
<br />
<br />No.
<br />
<br />Supera~oe~ U~nse ~n. 31386
<br />
<br />2B, FOR OWNER INSTALLATIONS
<br />
<br />Mafling Addr~gg [ Phone
<br />
<br />City/State;Zip
<br />
<br />The installa6on is beblg made on property I own which is nC~ ira, ended ftc sale
<br />
<br />Owners Signature .........
<br />
<br /> 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 phm 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 />MC 15-34 11/91
<br />
<br />S]T~.~, ,~iR!0~ 00U.i,,!? yPermlt No,
<br />Date..UI/DING/NSPECT/c f'i
<br />
<br /> Issued by:
<br />
<br />4+ IeEE SCItEDULE (Complete scad enter total in A l below)
<br /> Number of Inspections pe~ permit allowed ---]
<br />
<br />A.
<br /> Residential
<br /> Per
<br /> Unit
<br /> 1
<br /> Service Included: Items CosI (each) Suml
<br /> 1000sas, fi, or less 885,00 4
<br /> Each aclditin~,1500 sq. ft.
<br /> Of pOft~Oa thereof $1 fi.00 __
<br /> Limltod Energy $20,00 1
<br /> Each ManuFd Home or Modular
<br /> Dwelling SeIvle~ or Feeder 840,00
<br />
<br />B. Ser*io~$ or Ieeeders (Does not inlcude branch c/rolits, ~e~ gecticml
<br /> Installation, Alterations or RelocaUort1
<br /> 50.00
<br /> 200 amps or less $ $60,00 50.00
<br /> 201 amp~ to 400 amps __ 2
<br /> 401 ~m~ to 600 amps Sro0.00 __ 2
<br /> 601 aml~ to 1000 am[~ $1~0,00 __
<br /> Over 1000 ~*aps or ~o1[~ __ $300,00 2
<br /> Reconnec~ c~ly $40.00 __ 2
<br />
<br /> C. Temporary Services/Feeders
<br /> Instal]auon~ Alteration, or Rdoeaflon
<br /> 200 amps o~ less $S8.00
<br /> 201 aml~ m 400 amps $40.00
<br /> ~01 amps to fi00 ampS $$0,00 --
<br /> Over 600 craps or 1000 volt~
<br />
<br /> D. Branch Circuits
<br /> New, Alteration, or Extension Per Panel
<br />
<br /> a) The fcc for branch circuits with
<br /> pureh~e.qf ~erviee o~ feeder
<br />
<br /> ~ brmach c~reult $2.00
<br />
<br /> b) The fee for branch elrcuts ~out
<br /> purchase of ~emdee or feeder fee
<br />
<br /> First branch circuit $$5,00
<br /> Each additional branch cimuit $2.00
<br />
<br /> R. Miscellaneous (Service or Feeder Not Included)
<br /> Each p~mp or in/gatic~ elY:lc $40.00
<br /> Each sign or outlin~ fighting ] $40.00 /40. 002
<br /> Signal ekeuk(s) o~ a ]JgAitsd
<br /> panel, alteratlo~ or extension $40.00 __ 2
<br />
<br /> E }gaeh additional Inspection
<br /> Over ~he allowable in any of Ibc
<br /> above, per In~pectlon $~8,00
<br />
<br /> G-. Minor In*tallation
<br /> Pack of I0 labels @ $$.00 each $80.00
<br /> (sold only to electrical contractor$)
<br />
<br /> H. Other
<br /> (As required by Building Official)
<br />
<br />Al, Eater total of fees from Sec.//4
<br />A2. Add 5% surcharge (,05 x Al)
<br />
<br /> Subtotal
<br />
<br />B. Enter ~5% of llne A1 fo~ Plan Review
<br /> (Sec. 3), if required
<br />C. InvestlgatlcmFee (ff required)
<br />D, ReinspeeQon Fee ($25,00)
<br />
<br /> TOTAL AMOUNT DUE
<br />
<br />$ 90.00
<br />
<br />$~
<br />
<br />8 94.50
<br />
<br />Receipt No. , ............
<br />
<br />
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