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I FOR OFFICE USE ONLY <br />~ Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone SSS-5147 8:00 am - 4:30pm <br /> Cade-A-Phonm 588-7904 <br /> FAX: SSS-vgnS SiTE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />1, LOCATION OF INSTALLXFION <br /> <br />Directions <br /> <br />PERM1TS ARE NON-TRANSFERABLE AND NON-REFUNDAB LB AND <br />I~XPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPFANDI~D FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />Pro~ Own*r <br />M~g Address [ Phone <br />City/State/Zip <br /> <br />The installation is being made on pmi~rty I own which is not breaded for sale, <br />lea~c, or rent. <br /> <br />3. 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 does not suspend the <br />required submissioa of lighting power calculations, plans, <br />and specifications when req0ired by the Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br />MC 15-34 11/9] <br /> <br />4. FEE SCHEDULE (Complete arid e-na:r total in Al below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Unit <br /> Semite Included: <br /> <br /> 10~ sq. fi, ~ less $85.00 <br /> Each ad~al 5~ sq. ft. <br /> m~,~ th~of $15.00 <br /> ~a ~n~y <br /> 8ach ~ufd ~ome or M~ular <br /> Dwe~ng S~ or Peader <br /> <br /> 200 amp~ or Jess $50.00 <br /> 201 amp~ to 400 amps $80,00 <br /> 401 amps to 600 amps $100.00 <br /> 601 aml~ to 1000 amps __ $130,00 <br /> OVer lO00 ampg or VOlts __ $800,0~ <br /> Re~ormect only __ Sd0.00 <br /> <br />C, Temporary ServteeaLPeeder5 <br /> Installation, Alteration, or Relocation <br /> 200 amps or less __ $35,00 <br /> 201 ~npa to 400 amps __ Sd0,00 <br /> 401 amps to 600 amp~ $50.00 <br /> Over 600 amp~ or 1000 volts <br /> seC ,,~r' above <br /> <br />D. Eraneh Circuits <br /> <br /> a) Thc fee for branch circuits with <br /> gomhasc d ,q st~ic~ or fe¢O¢r, fe~ <br /> <br /> Each branch ckeuit .... $2.00 <br /> <br /> b) Thc fm i~r branch drcuts withont <br /> lgltchase of $~B, iee or feeder [~e <br /> ~irst branch circuit / $35,00 <br /> Each additional, branch circuit ~ $2.00 <br /> <br />1~, Miscellaneous (Service or Feeder Not Included) <br />Each pu~p or imga6.on circle $40.00 <br />I~ach sign or outlin¢ llghllng $40,00 <br />Signal eJxcuit(s) c~ a l/rolled e~ergy <br />pan~l, alteration or extension SdO,00 <br /> <br />F, Each additional Inspection <br />over the allowable ~ any of the <br />al:h'm. I~ Impection $,35,00 <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels ~ $5-00 each $50.00 <br /> <br />II. Other <br /> ( As r*q~Jr~d, by B~ildbjg Official) <br /> <br />5. FEES <br /> Al. Eater total of fees from Sec, #4 <br /> A2, Add 5% sarchavgc (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter ~% of ~ne A 1 for Plan R~view <br /> <br /> C. ~vesfigatlonFe~ (if ~qo~d) <br /> D, Relnsp~fion Fee ~,~) <br /> <br /> 'mT~L~MOU~ ~ <br /> <br /> Receipt N,o, , <br /> <br /> <br />