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iFdR omc use ONLy <br />[ Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING ]3ISPECTION <br /> 220 High Street NE <br /> Salem, Oxegon 97301 <br /> <br /> Phone 555-5147 8:00 am- 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 58S.7948 S~T~_ #: <br /> <br />ELECTRICAL PERMIT APPLICATION' <br />P/ease complete afl Sections, I through 5 <br /> <br />pERMITS ARE NON-TRANSFERABLE AND NON-~FUNDABLE AND <br />EXPIRE Lv WORK ~S NOT STARTED W1TI41N 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR. 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />ProI:cny Owner <br /> <br />Mailing Add,ess Phone <br /> <br />City/St atef~ip <br /> <br />The installation is being mad~ on p~opcrty I own which i~ not irltended for sale. <br /> <br />Owners Siguatu <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete S~ction <br /> 5~ 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 />aM specifications when required by the Oregon Structaral <br />Specialty Code, Chapter 53. <br /> <br />Date: <br /> <br />Permit No. <br /> <br /> Issued by: <br /> <br />4. FEE SCHEDULE (Complete and en~r total in A1 b~low) <br /> <br /> Nlamber of Inspegtlons per permit athiw~ <br /> <br />A. <br /> ReSidential <br /> Per <br /> Unit <br /> Service htcluded~ Itern~ Cost (each) Sum <br /> <br />Each additional 500 sa. ft. <br /> T' .or po~ioa thereof <br /> ~am~ted :Snetgy $20,00 <br /> Each Mannfd Home or Modular <br /> Dwe~lling $ervlc~ or Fe~d~ $40,00 2 <br /> <br /> Installation, Alterations or R~hieatlon <br /> 200 a~ o~ [~s ~ ~'60]00 2 <br /> 201 amp~ to 400 ~mps ....... 2 <br /> ~01 amps to 600 araps ~ $100,00 <br /> 601 amps to 1000 amps $130,00 -- <br /> C~r 1000 amps ~ volts 9~00,00 __ <br /> Reecnmeet ~Iy $40,00 __ 2 <br /> <br />C. Temporary Servicxs/Feed. era <br /> Installation, AIt~-atinn, or Relocation <br /> 200 amps or less ~ $8500 .... 2 <br /> 201 amps to 400 amp~ $40.00 ~ 2 <br /> 401 amps to 600 amps $80,00 -- 2 <br /> <br /> Each branch cixcult ~ ga,O0 <br /> <br /> b) The f~ for bra~ch clreats without <br /> [mrcha~ Of, service or feedS,fee <br /> <br /> First branch circuit ~ $35,00 <br /> <br /> ~ach sign or outline lighting -- 940,00 , , 2 <br /> Signal cimult(a) or a limi~d enavgy <br /> <br /> al~ove, per La~peetlon 985.00 <br /> Pack of 10 hbels @ $$,00 each $50,00 __ <br /> <br />IL Other <br /> ( As required Icy Building Offic~a0 <br /> <br />$. FEES <br /> Al. Enter total of fees from SeC, 04 <br /> A2. Add 5% surcharge (.0S x Al) <br /> <br /> s~ <br /> B. En~r ~% of line A1 for ~an Review <br /> ($~, 3), if ~q~r~ <br /> C, Inv~t~ati~gee ~quimd) <br /> <br /> '~TAL AMOUNT DUE <br /> <br />MC 15-34 11/91 Reqelpt No. <br /> <br /> <br />