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I%. omc , US%NL¥ <br /> Received by:. <br />I Date: <br /> <br /> MARION COUNTY BUILDING INSPECTiO% <br /> Salem, Oregon 97301 ~ <br /> <br />ELEGTRIOAL PERMIT A.PPLICATION Date: MARION COUNTY <br />Please complete all Sections, 1 through 5 ~ ~ssued by: 'DtN6 INSPECTION, <br /> <br />1, LOCATION OFINSTALLATION <br /> <br />~,~ ~ c~s~. <br /> <br />PE~ ARE NON-~ANS~BLB ~D NON-~AB~ ~D"' ' ~ <br />~E ~ WO~ IS NOT STARTgD W~ lse DAYS OF ISSU~C8 1 <br />OR IF WORK lS SUSP~D~D FOR I se DAYS, l <br /> / <br /> <br />Contracto?s Board Reg. No. ~ ~ ~'~1 ~ I Job No. <br />Signature of Superv~s~g Election ~~ ~ ~ <br />Supew~oe~ l,i~se No. '~ ~-~ ~ '% I Phone <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br />Marling Address Phone <br />Cityctate£/~ip <br /> <br />The installation is heing made on proper~y I own which is net inlended for sale, <br /> <br />Owner's Slgnamm ..... <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 />4, F~}~ SCHEDULE (Complete and enter total in A1 I:~low) <br /> <br /> Numlmr of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Unit <br /> Service Included: Iteana Cost (each) Sttml <br /> <br /> 1~ sq. f~ ~ss $85,00 4 <br /> Egh afl~fi~l 5~ sq. ft. <br /> <br /> ~md Briery $20,00 ~ 1 <br /> Ea~ M~fd ~ome or M~uhir <br /> ~e~ Se~ or F~d~ $40.00 2 <br /> <br />E, $er~ or Feeders ~s not ~i~de branch ~i m~ts, see ~ecti~ I)) <br /> <br /> ~ amps ~ less ~ $~.00 ~ _c '~ 2 <br /> 201 am~ m 4~ ~ps $60,00 <br /> <br /> ~r I~ ~ps otvo~ $800.~ 2 <br /> ~et m~ $40.00 ~ 2 <br /> <br /> C, Temporary Services/Feeders <br /> Installation, Alteration, or Rd,>eat on <br /> 200 ampa or less $35.00 <br /> 201 amps to 400 amps $40.00 <br /> 401 ammp~s to 600 amps $80.00 <br /> Over 600 ~mps or lose volts <br /> <br /> D. Branch <br /> New~ Alteratlon~ or E~tenslon Per Panel <br /> <br /> a) The fee for branch dmcit~ <br /> l~ol~ha~e of ~erv~eh o~ fe,edcr fee <br /> <br /> Each branch e~reuit I $2.00 <br /> <br /> b) The fee for bra~ch drcuta without <br /> la~reh~Se of ~er~hce or fe~d~r ~.~ <br /> <br /> F~Is~ branch circuit $~5.00 <br /> Each addi~onal blanch circuit $2,00 <br />E. Mlsceltaneons (Service or Feeder Not Included) <br /> Each pump or inigaaon circle $40,00 <br /> -- $40,00 <br /> Ea,~h sign or outline lighting <br /> Signal c4rcuit(s) or a limhed energy <br /> panel, alteration or ext~lsion $40,00 <br />F. Each addltlonal Inspection <br />over the allowable Jn any of the <br />al:~,v~, pot Inspection $B$.00 <br /> <br /> Pack of I0 lal~l~ @ $5.00 each $~0.00 <br /> (voM o~y to gl~etrlcal contractors) <br /> <br /> (As raq~rgd by Bu£1d~ng Officio0 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 $ "~ ~ <br /> A2. Add ~% surcharge <br /> <br /> Subtotal $ <br /> <br /> B. Enter 2$%oflineA1 forPlanR¢view <br /> (Sec. 3). if required $ <br /> C. Invest[gaO. on Fee 0f requh'ed) $ <br /> D, Reinspeefico Fo* ($25,00) $ <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt Nc,, <br /> <br />$ -z IZ., i/) <br /> <br /> <br />