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"fShbmc .,Js . <br /> 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.Phorm: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Please complete afl Sections, I through 5 <br /> <br />SITE #: <br /> <br />Permit No. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />I. LOCATION OFINSTALLATION <br /> <br />pE~MI'/~ AR~ ~O~-'I'/r~A~$~RA~L~/'~D N Oy P.~'~/',~AB~ A/Po <br />EXp~E ~ WORK IS NOT STARTED W~ 1 $0 ]DAYS OF ~SSUANCE <br />OR IF WOP. K IS SUSPENDED FOR 180 DAYS. <br /> <br />lA, CONTRACTOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br /> Address { Phone <br />Mailing <br /> <br />City/State/Zip <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 />dfiS application. <br /> <br />This optional plan review program does not SuSpend the <br />rcttuired submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Co(lc, Chapter 53. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number of Inspeetlons per permit allowed <br /> <br />A. <br /> Residential <br /> l~r <br /> Unit <br /> <br /> Limltc~l Energy $~0,00 <br /> /.~ng Se_?i~eedcr $40.00 <br /> ~ amps or lcss ~ $50.00 ~ ~/ <br /> <br /> 401 amps to 600 amps <br /> 601 amps to 1000 amps <br /> Over I000 amps or voks <br /> P. eeom~ct only <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amtpss <br /> OVer 600 amps or 1000 volts <br /> sea~ "B" abow <br /> <br />D, Branch Circuits <br /> New, Alteration, Or Extension Per Panel <br /> <br /> a) The fee for branch c~rcu~ts with <br /> pu~Jhase ut ser~ce or fe~e~ fee <br /> <br /> Each branch e~reu~t <br /> <br /> b) The fee for branch c/routs without <br /> purchase of service or feeder fe~ <br /> <br /> First branch ei~uit <br /> l~ach adaitional branch ch-cult <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irdgatioa circle <br /> Each sign or oJtl[ne I~.ghQng <br /> Signal cir~ult0) or a lir01t*d <br /> panel, alteratlcaa or ext~si0~ <br /> <br />F- Each adaitlonal Inspoetinn <br /> over the allowable in a~y of the <br /> above, per Insp¢¢tlo~l <br /> <br />G. Minor Installation <br /> Pack of 10 labels @ $5,00 each <br /> (sold only to electrical contractors) <br /> <br />H. Other <br /> (A~ requlr~d by B uildin, g Official) <br /> <br />$100.00 __ 2 <br />$180.00 __ 2 <br />$soo,oo <br /> $40,00 <br /> <br />$35.00 --2 <br />$40.00 __2 <br />$80,00 __2 <br /> <br />$2.00 ........ <br /> <br />$2,00 <br /> <br />$40,00 2 <br />$40.00 ..... 2 <br /> <br />$40.00 ......... 2 <br /> <br />$50.00 <br /> <br />$. FEES <br /> Al. Enter total of fees from Sec, #4 <br /> A2. Add 5% stlrcharge (.05 x A1 ) <br /> <br /> (Se~. 3>, ~f teq~ired <br /> <br /> D. Reinsp~¢rion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />$ <br />$, <br />$ <br /> <br />MC 15.34 11/91 R~¢q~ No. <br /> <br /> <br />