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' [ FOR OFFICE USE ONLY <br />[ Received by: <br /> I Date: - <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8;00 am - 4:30pm <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br /> 1, LOCATION OF INSTALLATION <br /> <br />SiT[= #: q[J~'~ l~i,b Permit No. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Doscfipdon <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON,REFUNDABL~ AND <br />EXPIRE Il: WORK tS NOT STARTED wrrH1N 180 DAYS OF ISSUANCE <br />OR Il,' WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INffFALLATION ONLY <br /> <br />211. FOR OWNER iN~'I'ALI,ATIONS <br />Prol>edy Owner <br />Mailing Address , Phone <br />Cityetatef/,ip <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provMe plan review service it' you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />tiffs application~ <br /> <br />This optional plan review program does not suspend the <br />required sabmission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br />MC ]5-34 11/91 <br /> <br />4, FEE SCHEDULE (Complete and enmr loInl itl A 1 below) <br /> <br /> Number of Elspeetlons per permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) <br /> <br />10tN) s . ft. or less $85.00 __ 4 <br />Each [~dkional 500 ~q. <br />or portion thereof $1 <br />Limited Bncrgy $20.00 __ 1 <br />Each Manut'd Home or Modular <br />I'~¢lli~g Secdc~ or Feeder ~ : $40.00 -- 2 <br /> <br /> 200 amps or less <br /> 2l)1 amps to 400 amps <br /> <br /> 601 am~p~to 1000 aml~ -~ <br /> <br /> 200 amps or les~ <br /> 201 amp~ to 400 ~mp~ .... <br /> 401 amps to 600 amps <br /> Over 600 amps or 10tX} veils <br /> <br />D, Branch Circuits <br /> <br /> a) 'I'Ve fe~ for branch el rcUitS wilh <br /> t~u~.}J~ o{' ~ex~4ee or {~Je~ fee. <br /> <br /> 'Each branch circuit <br /> <br /> h) The f~ for branch elreuts ~v~lhout <br /> <br /> ~50,00 <br /> 80,00 r 2 <br />$100.00 -- 2 <br />$130.00 <br />$800.00 __ 2 <br /> $40,00 __ 2 <br /> <br />$35.00 __ 2 <br />$40.00 <br />$80,00 __2 <br /> <br />$2.00 <br /> <br />$95.00 5,~ <br /> Sa,oo <br /> <br />$40.00 <br />$40.00 ~ 2 <br /> <br />$40,00 <br /> <br />$35.00 <br /> <br />$5o.oo <br /> <br />Al, Enter total of face from S~c, 84 $ ~ <br />A2. Add 5% surcharge (,05 x Al) $ ,, <br /> <br /> ($~. 3), if mq~rM <br /> <br />D. Reinsp~m Fee ($~,00) $ .... <br /> <br /> <br />