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FOR OFFICE USE ONLY <br />Received <br />Date: <br /> <br />i MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> Phone 581t-5147 8:00 ~ - 4:30pm <br /> C~te-A-Phone: 588-7904 <br /> FAX: 555-?~48 SITE #: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />lmRMrrs ARE NON-TRANSFERABLE AND NON-P..~I~NDAB LE AND <br />gXPIRI5 IF WORK IS NOT STARTED WIT'rlI:N iSO DAYS OF I$SUA~NCg <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2B. FOR OWNER INSTALLATIONS <br />property Owner <br /> <br />MaL~ng Add.ss Phone <br />City/~tate/Z{p <br /> <br />The inslallatlon ia berg made on property I own which is not intended for sale, <br />/ease, of rent. <br /> <br />3, PI,AN 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 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 />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> Number of Inspectlon~ per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> UnR <br /> Service InCluded: Items Co~t Leach) SumI <br /> <br /> 1000 sq, fl, ct less ~ $85,00 __ <br /> Each additional 500 sq, ft, <br /> ~n porat~ themof $15.00 <br /> Limited Ene " SR0.00 -- <br /> <br /> Dwelling ServSce or Feeder $40,00 , <br /> <br /> 200 amps or less $$0,00 __ 2 <br /> 201 amps m 400 amps $60.00 __ 2 <br /> 401 amp~ to 600 amps ~ $100.00 ~ 2 <br /> 601 am to 1000amps ~ $180.00 <br /> Over 1~ snaps or volts $S00.00 2. <br /> Recormect only $40.00 __ 2 <br /> <br />C, Temporary ScrvicesfFeed~$ <br />installation, Alteration, or Relocation <br />200 amps or Jess ..... $35,00 2 <br /> 40.00 ..... <br /> 201 amps to 400 amps $ }80.00 <br /> 401 mpa to 600 amps <br /> 2 <br /> Ove,r,~,6,0,0, amps or 10{30 volts <br /> <br />D, Branch Clreuff-q <br /> New, Alteration, or ]~xtenslon Per Panel <br /> <br /> a) The fee for branch ~rcults with <br /> <br /> Each by, tach circuit ~ $~.00 .... <br /> <br /> b)Tn¢ fee for blanch clreat$ w~LQut <br /> pll ¢c:1~.~ ~e. of seDrio~ or feede.~ fee <br /> <br /> First branch circuit $35.00 <br /> Bach additional branch circuit $2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not lqchided) n,~../. <br /> Each pump or irrigation circle t $40,00 <br /> Each sign or outline lighting $40 ,OO <br /> Signal circuit(s) or a 1/mired energy <br /> panel, alteration or extenslotl $40.00 <br /> <br />F. Each additional In~peetlon <br />Over the allowable in any of the <br />abo,~e, per inspection $$$.00 <br /> <br />~. Minor Installation Labels <br />Eaek of 10 labels @ $5,00 each $SO.O0 <br />(sold onJy lo electrical eotdractors) <br />H. Other <br />(As required by Building Official) <br /> <br />FEES <br /> <br />A 1, Enter total of fees f:om See. #4 <br />A2, Add 5% surchaffge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B, Emer 2.5% of line A1 for Plan Review <br /> (Sec. 3), if reqdirad <br /> <br />D. Reinspection Fee ($~,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MC 15-34 11/91 Regeipt No. <br /> <br /> <br />