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IFOROFFICE USE <br /> ONLY <br />Received by:. <br />,~ate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:301ma <br /> Code-A-Phone: 588-79~4 <br /> FAX: 558-7948 <br /> <br />I'"'"'"ELECTRICAL PERMIT APPLICATION ............. <br /> ....... Please complete all Sections, I through <br /> <br />I- L(X:ATiON OF INffI'ALLATION <br /> <br />Job^ddress 747~' ~N~=P_Iv~R~ ~> <br /> <br />P~ ARE NON-~S~B~ ~ NON-~ <br />EX~E ~ WORK I$ NOT STARED W~ 180 DAYS <br />OR IF WORK IS SUSP~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />ISlect rical Co,tractor i_ A~ ~,,,/ ~-O~1 ~S <br /> <br />Contractor's Boat~ Res. No. <br /> <br />Signature of Suitor,rising l~lcctr~cian <br /> <br />Sul~rvlsor's License No. <br /> <br />2B, FOR oI~rNER iNSTALLATIONS <br /> <br />PrOl~ay Owner <br /> 'Phone ' <br />MaJlin$ Address <br /> <br />City/State/'~p ' <br /> <br />The mstallalxon x~ bemg made on pmpen~ I own which Is nec mteraled for sale, <br /> <br />Ownees Signature ................... <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you ~omplete Section <br /> 5B and submit two (2) sets of plans and specifications with <br /> this application. <br /> <br />This optional plan 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 Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />SITE #: Permit No, <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complvte ired enmr total m A 1 I~low) <br /> Number of Inspections p~ permit allowed -~ <br /> <br />A. <br /> Rerddential <br /> Per <br /> Unit <br /> 1 <br /> ~e~iee Included: It--s Cost (each) Sum <br /> <br />10~ sq, ~ ~ss $85.00 .......... 4 <br />~ach ad~fi~ 5~ sq, ~, <br />~ ~ffi~ them& $1 g.O0 <br />~d B~gy $20.00 ....... 1 <br />~a~ Manufd H~¢ or M~ular <br />~ng Se~ ~ Feeder $40,00 2 <br /> <br />B. Ser~ or Peters (D~s not ~l~e branch cim~ts, acc section D) <br /> <br /> Installation, Alterations or Relocation <br /> ~0 amps e~ less <br /> 201 ~rnps to 4~0 ~nps $60,00 <br /> 401 aml~ ~o 600 amps $100.00 <br /> 001 am~pSllo 1000 amps <br /> Over 1000 amps or volts SS00.O0 <br /> R~conneet only $40,00 <br /> <br />C. Temporary SewloedFeeders <br />Installation, Alteration, or RelocaSon <br />g00 amps or less $8S.00 <br />201 amps to 400 amps $40.00 <br />40I ~rnpa to 600 amps $60,00 <br />Over 600 amps or 1000 volts <br />$~ "B" above <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch ~mits with <br /> <br /> Each branch cAreuit ....... J, , , $2.00 <br /> <br /> b) Thc fee fcc branch clguts ~ <br /> onrehase of ser~ine orj. r~l~L fee <br /> <br /> First branch circuit $S5,00 <br /> ~ach additional braach ch'~uit Sa. OO <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pUmp or irrlsatlc~l clinic $40.00 <br /> Linch sign or ou0in~ llshdnng -- $40.00 <br /> Signal ~ir~uit(z) or a llmltcd cne~y <br /> panel, aherat~on or cxton$1~ll $40.00 <br /> <br />F. Each additional Inspection <br />over the allowable in any of the <br />above, ~ InSl~on $95.00 <br /> <br />G. Minor Installation Labels <br />Pack of 10 labd~ @ $5,00 each $$0.00 <br />(sold only to electrical contractors) <br /> <br />H. Other <br /> (As reqMred by Building <br /> <br /> 5. FEES <br /> Al. Lint~r total of fees from Sec. #4 <br /> A2. Add 5% surcharge (,05 xA1) <br /> <br /> Subtotal <br /> <br /> B. Enter 2..5% of Line Al for Plan R~view <br /> ($~, 3), if re4uir~d <br /> C, hvezrigation Fee (ffrequi~ed) <br /> D, Re. inspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />............. Re*eipt No, <br /> <br /> <br />