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IFQR OFFICE USE ONLY <br /> Received by:_ <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Sin:et NE <br /> Salem, O~gon 97301 <br /> <br /> Phone 588-5147 $:00 am - 4:30pm <br /> Co,e-A-Phone: 588-7904 <br /> PAX: 588-79~g SITE #: <br /> <br /> I <br />ELECTRICALPERMITAPPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I'~TS ~E NON-TRANSb~B~ ~ NON-~AB~ AND <br />EX.RE iF WORK IS NOT START~ W~ 180 DAYS OF ISSU~CE <br />OK I~ WORK IS SUSPENDED FOR 180 DAYS, <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Elecmeal Contractor <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />pmpar~y Owner <br /> <br />MaiLing Address Phone <br />CAgy/Stare/Zip <br /> <br />)'Tho itlstallaaon is b~ing mad~ on prop:ny ][ own which is ~ot inw. nded for sale. <br /> PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B a0d 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 />MC 15-34 11/91 <br /> <br />4, FEE SCHEDULE (Complete and enter to*al in A 1 below) <br /> <br /> Number of Inspoctlotls per permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> UnR <br /> Service Included: Items Co~t (each) <br /> <br /> lO00 s . ~ or less ~ $85,00 <br /> ~a~ ~fional 5~ sq. <br /> ~ ~ffi~ thereof ~ $15.00 <br /> L~i~ Enemy $20,00 __ <br /> Each Ma~fd H~* ~ <br /> Dwc~ng Se~i~ or Feeder $40,00 <br /> <br /> ~ 50.00 <br /> 200 amps or le~ <br /> 201 amp~ to 400 amps <br /> 401 ~mps to ~ amps $100.00 <br /> 601 amps to 1000 amps $1S0.00 <br /> Over 1000 amp~ or volta $300,00 <br /> R~cormect only -- $40,00 <br /> <br />C- Temporary ServtcedFeeders <br /> <br /> 200 amps or ins: <br /> 201 amps to 400 amps $40.00 <br /> 401 amps to 600 amps $80.00 <br /> Over 600 ~-mpa or 1000 vol~s <br /> <br />D. Branch Circuits <br /> New, AIteration~ or Ex'tension Per Pand <br /> <br /> a) The f~ for branch 6rcu~t,s <br /> purcha~e,.of $e~ice or fcedgL~[ee <br /> <br /> Each branch elmuit ~ $2.00 <br /> <br /> b) 'Die f~e for branch cireu[s without <br /> ,p~rchase of ~¢rviqq.Or feeder fee <br /> <br /> Piz~t branch ~imuit <br /> Each additional branch <br /> <br />E. Mlscellant,~m~ (Service or Feeder Not Included) <br /> Each pump or ir~gafion circle $40.00 <br /> Each sign or ourl/ae li. ghtlng -- $40.00 <br /> Signal eX,cult(s) or a limited energy <br /> panel, alteration or ext0nsion ~ $40,00 <br /> <br />F. Each additional <br />over the allowable in any of the <br />above, per Inspecaon $35.00 <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labe,,Is @ $5,00 each <br /> (~old only to *lectrical contractors) <br /> <br />IL Other <br /> ( As reqtdr~d by Building Official) <br /> <br />5, FEES <br /> Al, Enmr total of f~e~ from S~¢, <br /> A2. Add 5% surcharge (.05 x A 1) <br /> <br /> Subtotal <br /> <br /> B. Enler 25% of H~e A 1 for Plan Review <br /> (Sec, 3), if rcrLulr~d <br /> C. InwstigatlonEee (if required) <br /> D, Relnspecfic~ Fee ($25.00) <br /> <br /> TOTAl, AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />