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FGR oI~FICE USE ONLY <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 9.20 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5 I47 8:00 am - 4:30pm <br /> C-~le-A-Phonc: 588-7904 <br /> FAX: 588-7948 SIIE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Petmit No. <br /> <br />l. LOCATION OEINSTALLATION <br /> <br />pERMITS ARE NON-]I~NSFERABLE AND NON-REFUNDABLE AND <br />~XPIRE IE WORK IS NOT STARTED W1TI-~N 180 DAYS OF ISSUANCE <br />OR I~ WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER IN~I'ALLATIONS <br /> <br />propen¥ Owner <br />Mailing Address Phone <br />CAty/~t at~/'Zip <br /> <br />PLAN REVIEW SECTION <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 plan review program do0s not suspend tho <br />required submission of lighting power calculations, plans, <br />and specificadons when required by thc Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 <br /> <br />4_ FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> Number of Inspectiolls p~r permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> 1000 sq, f[. or less $85.00 -- <br /> Each additional 500 sq. ft. <br /> or portion thereof $ J $,00 <br /> Lim/ted Energ $20.00 <br /> Bach Manu£d [4oma or Modular <br /> Dwelling Scz~.cc or Feeder $40,00 __ <br /> <br /> Installattsn, Al{erationaorRelocatlon ~ / <br /> 200 amp~ or less _ ~ SS0.00 <br /> 201 amp~ to 400 amps , $$0.00 <br /> 401 amps to 6(Y0 amg~ $100 <br /> 601 amps to 1000 amps $130.00 <br /> Over 1000 amp.~ or volts $1300.00 <br /> I{¢e. orme.~t only $40.00 -- <br /> <br /> Installation, Alteration, or Relocatlo~ .... <br /> 200 snaps or le~a ~ $3500 <br /> 201 amps zo 400 amps $40.00 <br /> 40! amps to 600 amps $1~0.00 <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Circuits <br /> <br /> a) The fe~ for branch dm{ts with <br /> nnrchase=of ~cwine or {~eAe~ re, ) <br /> Each brach t~rcuit $2,00 <br /> <br /> b) '[l~ fee for hrarmh ckc~ts .without <br /> purchase of ~q ¢.wjc,e, or Ieeder fee <br /> <br /> First branch circuit __ $35,00 <br /> Each additional brach aimult $2,00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or inigatin~ c~.rel* $40.00 <br /> Each sign or outline ll,ghtJng -- $40.00 ...... <br /> Signal citcuit(~) or a bn~ted energy <br /> panel, alteration or extension __ $40,00 <br /> <br /> F. Each additional Inspection <br /> c,,'et the allowable in any o~ die <br /> above, per In,W~ction -- <br /> <br /> Pack of t0 labels ~ $5.00 each__ $$0,00 <br /> (~ol~ ordy to d~ctrlcal <br /> H. Other <br /> ( AS reqcdred by BuHdia$ Officlall <br /> <br />5, FEES <br /> Al. Enter total of fees from Sec. fi4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> ¢Seg, 3), if rcqgir~ <br /> C. Invcstlgatjon Fee (il-requlred) <br /> D. Relnspection Fcc ($25,00) <br /> <br /> TOTAl· AMOUNT DUE <br /> <br /> <br />