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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> Salem, Oregon 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OFINb'FALLATION <br /> <br />City ~-t~_/~ I CROSS St. <br /> <br />PERMrI'S ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE l/2 WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 1 S0 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />;IlL FOR OWNER INSTALLATIONS <br /> <br />Ma~llng Address <br /> <br />Phon~ <br /> <br />C~!:y/State/Zip <br /> <br />The ins;itllation is 'being made on prel~r~y I own which is not intended for sa]e., <br /> <br />Owners Signature <br /> <br />3, ]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 pine 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 Ctxtc, Chapter 53. <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Codc-A-Phone: 588-7904 <br /> FAX: 585-7948 <br /> <br />MC15-$4 11/91 <br /> <br /> Date: ~4~!O,N om mrv <br /> <br /> Number of Insp~tlo~)s per permit allowed ~ <br />A. <br /> Residential <br /> Fer <br /> Unit <br /> 1 <br /> Semite Included: Irma Cost (each) Sum/ <br /> <br /> Each additional 5(~ sq, fl, <br /> <br /> L~ite~ Enemy $20.00 __ ~ <br /> Each Maned Home or M~ular <br /> Dwe~ng Se~m ~ Feed~ $40.00 ,,, 2 <br /> <br /> 2~ amps ~ less $50.00 ~ 5 ~ ~ <br /> ~I ~p~ m 4~ ~ps ~ $60.00 <br /> ~1 ~ to 6~ amps $100,00 ~ 2 <br /> ~1 am~)o 1~ am~ $~80.~ __ 2 <br /> ~r I~ naps or voks $800.00 __ 2 <br /> ~ect ~y $40,00 ~ 2 <br /> <br />C. Temporary Servlces/leeeders <br />Installation, AltcwatiOn~ or Relocation <br />200 amps or less $8S.00 <br />201 amps to 400 amps $40.00 <br />40I mmmp~s to 600 amps $80.00 <br />Over 600 amps or lO00 volts <br /> <br />D. Branch Circuits <br /> New, AIt~ation, or Extension Per Panel <br /> <br /> a) The fe~ for br~mch circuits with <br /> l?.9,~.l~&s~,,of, service or feeder fee <br /> Each branch circuit .~ $2,00 <br /> b) The fee for branch clrcmx without <br /> <br /> First branch cimuit <br /> Each additional branch circuit $2.00 <br /> <br /> Each Immp or in/gati~m ci,,ml, e $40.00 <br /> <br /> Pack of I0 labels (&__ $5'.00 each $~0,00 <br /> ( AS r~qtdred by Building Offlcia0 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec, $$4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Emcr25%ofllneA1 for Plan Review <br /> (Se4. 3), if mq~dred <br /> C. InvestigationFee; (if required) <br /> D. R¢inspecfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ K <br /> <br />Receipt No. , ....... <br /> <br /> <br />