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Received by:_ <br />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: 588-794S <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Please complete all Sections, 1 through 5 <br /> <br />1, LOCATION OFINSTALLATION <br /> <br />JobAddmss <br /> <br />Cross St. <br /> <br />PERMYI'S ARE NON-TRANSFERABt,E AND NON-REFUNDABLE AND <br />EXFIRE IY WORK IS NOT STARTED W1TI-11N lS0 DAYS OF ISSUPuN'CE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Ele~rical Comraetor ~ ~t~- ~ ~r-~q~ y ~ [Phone ~- <br /> <br />Signatu~ of Su~is~g <br /> <br /> Ph°ne N°~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Mamns Address l Phon~ <br /> <br />City/State/Zip <br /> <br />Fhe installation is ?ring made on property I own which is not intended for sale, <br /> <br />Owner's Signature <br /> <br />Wc 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 phtn review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structaral <br />Specialty Code, Chapmr 53. <br /> <br />MC 13-34 11/91 <br /> <br /> SITE #: Ef '[~ - <br /> <br /> Date: '~:x~, ~' fee, '" <br /> Issued by: ~13~0O ~ ~,{ <br /> <br />4. ~EE ~C~EDU~E (C~plele <d enler [oml ~ A1 ~ow) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: items Cost (each) Sum <br /> <br /> 1000 sq. ft. or less $85,00 __ <br /> Each additional 500 sq, ft, <br /> or poffic~ thereof $15.00 <br /> Lke~ted Energy $20.00 <br /> <br />Each Manufd Home or Modular <br />DweR{ns 8e~ie~ or Feeder $40.00 <br /> <br />B, Services or Feeders (Does not inlcude branch circuits, see section D) <br /> <br /> Installatlo% Alterations or Relocation <br /> 200 amps or less <br /> <br /> over the allowable in any of the <br /> above, per Inspection <br /> <br />Other <br /> ( As r~quir~d by Building Officio0 <br /> <br />50.00 <br /> 0.00 2 <br />$1oo,oo __ 2 <br />$180.00 __ 2 <br />$300.00 __ 2 <br />$40.00 ,,, 2 <br /> <br />$35.00 __2 <br /> 40.00 <br />t80.00__2 <br /> <br />$05,00 <br /> $2,00 <br /> <br />$40.00 __2 <br />$40.00 2 <br /> <br />$40.00 __~ <br /> <br />$35,00 <br /> <br />$5o.oo __ <br /> <br />5. FEES <br /> Al. F~nmr total of fees from Sec. #4 <br /> A2. Add 5% mreharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of linc A 1 for Plan Review <br /> (See. 3), if required <br /> C, InvestigationFee Of required) <br /> D- Rcinspccfion Fcc ($25,00) <br /> <br /> 'IO'I'AL AMOUNT DUE <br /> <br /> Receipt No, <br /> <br />7,9 <br /> <br /> <br />