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IFOR OFFICE USE ONLY <br /> Reeci'ved by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Street NE <br />Salem, Oregon 97301 <br /> <br />Code-A-Phone: 588-7904 <br />FAX: 588.7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 ~! ~ ,c <br /> <br />I, LOCATION OFINSTALLATION <br /> <br />~E~ ARE ~O~-~S~B~ ~ NO~-~A~ A~ <br />EXP~E IF WORK I3 NOT STARED W~ lse DAYS OF ISSU~CE <br />OR IF WO~ IS SUSP~DED FOR 180 DAYS, <br /> <br />~A. COH~RACTOR INSTALLATION ONLY <br /> <br /> Conffactor ] Phone <br />Electrical <br /> <br />lob No- <br /> <br />Mailing Address <br />PmlYerty Owner <br /> <br />ContractOr'S Board Reg. No. <br /> <br />Signalo~ of Suyx~/v{sthg Ele~txi~fian <br /> <br />Supe~vi$or'$ L/~nse No. , , ] Phone No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />The installation is b~in$ mad~ on proIm~ I own which is not intended for~e. <br /> <br /> ,, G/..,,, <br /> <br />We will provide plan review ~rvice if you complete Section <br />5B and stthmit two (2) sets 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 />MC 15-34 11/91 <br /> <br />SITE #: <br /> <br />PermJtNo. <br /> <br />Issued by; <br /> <br />4. FEE SCHEDULE (Complete and ~ntcr total i~ ^ 1 below) <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Ser~io~ Included: Xt~s C~t (each) ~uml <br /> <br /> 1~ sq, ~. ~less $85.00 4 <br /> E~h ad~ 5~ sq, fl. <br /> <br /> DW~ Se~ or Feed~ $40.00 .. 2 <br /> <br /> B. $e~ or Feeders (D~a not ~l~de bmn~ c/mu/ts, see s~cfion D) <br /> <br /> ~ am~ ~ less $ $60.00 <br /> ~1 ampam 1~0 ~ $130.00 <br /> Re~ect ~ly ~ $40,00 -- 2 <br /> <br /> C, Temporary Services/Feeders <br /> installation, Alteration, or Relocation <br /> 200 amps or less $35.00 <br /> 10t amps to 400 amp~ $40.00 <br /> 401 am s to 1500 am s $80.00 <br /> Ovcr~ amps or l~O volts <br /> <br /> D. Branch Circuits <br /> <br /> a) The fe~ for branch ~rcuil: <br /> <br /> ~¢h bt, tach c~rcult ~ $~,00 <br /> <br /> h)Thc fee. for branch circuts ~/~hout <br /> l~cba~e of service ol;~-rmter <br /> <br /> F~t branch dreui[ $35.00 <br /> Each additional branch ¢~cuit ~ <br /> <br /> E, Miscellaneous (Servie~ or Feeder Not <br /> ~achlmmporirfigafionClrcle , ] ~- SanOilJ <br /> Each dgn or outline lighting .... $40.00 <br /> Signal ehrcuit(s) or a limited <br /> panel, altera[iext ex extrusion $40.00 <br /> <br /> F. Each additional <br /> over the allowable in a~y of the <br /> above, l~r ~spectio~ $35.00 <br /> <br /> G. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 ¢ae.h $50.00 <br /> (sold only to electrical contractors) <br /> <br />~H, Other <br /> ( Ac re~aired by Bat/ding Offida/) <br /> <br />5. 'FEES <br /> Al. Emer total of fees from Sec. #4 <br /> A2. Add 5% surcharge ¢05 x Al) <br /> <br /> Subtoml <br /> <br /> B, Enter 25.% of linc A 1 for Plan R~vi2w <br /> (S~. 3), if ~q~ <br /> <br /> '~TAL AMOU~ DUE <br /> ~i~ No, ,, , <br /> <br /> <br />