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DRFeaOcR OFFICE USE ONLY <br />rived by:. <br />te: <br /> <br /> MARION COUNTY BUILDING INSEE, CTION <br /> COMMUNitY DEVELOPMEm <br /> <br /> Salem, Oregon 97301 ~ ~ <br /> P~ne 588-5147 8:~ ~- 4:3~ 0~ 0 6 [~9~ermit <br /> ~e-A-~: 558-7~ <br /> F~; 588-7~8 SITE 8: <br /> I MARION COUNTY <br />ELECTRICAL PERMIT APPLICATION Dat~uI[DING INSPECTION <br />~1~ ~mploto ~ Soctions, ~ through ~ Issued by: <br /> <br /> 1, LOCATION OF INSTALLATION <br /> <br />.......... <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WI'H4[N 180 DAYS OF ISSUANCE <br />OR LF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CObrPRACTOR INSTALLATION ONLY <br /> <br />Electrical Cc~tmctor ( <br /> <br />MaJl~g Addles: <br /> <br />Signature of Supervising Electrician <br /> <br />Supervlsor', I,icenso No. <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Pm~rty Owner <br />Mailing Address / Phone <br />City/State/Zip <br /> <br />The imtallatlon is being made on prop~:xy I own which i: nc~ hitendcd for sale. <br /> <br />Owners Signature <br /> <br /> PI,AN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) gets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />l'¢quJred sublnissiou of lighting power calculations, plans. <br />and Specifications when required by the Oregon Structural <br />Specialty Code. Chapter 53. <br /> <br />MC I5-34 8/94 <br /> <br />4, FElg $CIIEDULE (Complete and emer tolal in A 1 below) <br /> <br /> Number of Inspe~ztions per permit allowed -~ <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> SerVice Included: Items Co*t (each) $otn <br /> 10~0 s , ~ or less $85,00 4 <br /> <br /> ~ ~ffim ~he~of $15.00 <br /> L~tod Enemy $~0.00 __ 1 <br /> <br />Each Manufd Home or Modular <br />DwoRin8 $erdo~ or Feeder $40,00 2 <br /> <br /> I#stallatlon, Alterations or Relocation <br /> 200 amp~ or leas <br /> 201 amps to 400 zunps <br /> 401 amps lo 600 amps <br /> 601 amps~s to 1000 amps <br /> Over 1000 amp~ or volt-~ <br /> Reconnect o~ly <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps otless <br /> 201 amps to 400 amps <br /> 401 amps to 600 amp~ <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Circuits <br /> New~ Alteration~ or Ex~an$1on Per Panel <br /> <br /> a) Thc fee for branch circuitq.kv~th <br /> mlmha~_9,[,,sg~'~c~ or feodcr fee <br /> <br /> Each branch c, lmult <br /> <br /> b) The fee for brtmch clreuts without <br /> <br /> Pack of 10 labels L~ $~,00 each <br /> <br /> ~$0,00 <br /> 60,00 <br />$100.00 <br />$180,00 2 <br />$300.00 <br /> $40.00 __ 2 <br /> <br />$85,00 <br />$40.00 <br />$80.00 <br /> <br />$2,00 <br /> <br />$85.00 ~ <br />$2,00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec, #4 <br /> A2. Add 5% snrchatge (,05 x Al) <br /> <br /> Subtx~tal <br /> <br /> B. Etller25%oflineA1 for Plan Revlew <br /> (S¢.c. 3). if require~l <br /> C. InvestigatJon['eer¢~ (if ruquimd)~ <br /> D. Rein~.pe. ct{o~x Fee ($25,00) <br /> <br /> · tryr^L AMOUNT DUE <br /> <br /> Receipt No .......... <br /> <br /> <br />