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'FOR OFFICE USE ONLY <br />] Received <br />[Date: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8;00 am - 4:30pm <br /> Code-A-Phone; 588-7904 <br /> VAX: 588-7948 SiTE #: <br /> <br />Date: <br /> <br />issued by: <br /> <br />Dim<dons <br /> <br />PEI~MITS AR B NON-TRANS Fi]FABLE AND NON-RBp'UNDABI~ Al'rD <br />EXPIRE LF WORK/$ NOT STARTED wrrltlN lg0 DAYS OF ISSUANCE <br />OR IF WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR 1N,~'TALLATION ONLY <br /> <br />MaillngXthlmss 1410 MADISON, ST..,, <br />Pro.ny Owner ] ~1~ <br /> <br />;lB. FOR OWNER INSTALLATIONS <br /> <br />Mailing <br /> <br />City]~t ate~ip <br /> <br />The installation ia behlg made on property I own wMeh is not intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review servlee if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br /> This optional phm review program does not suspend the <br /> required submission of lighting power calculations, plans, <br /> a,d specifications when required by the Oregon Structural <br /> Specialty C(×t¢, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4, FEE F~CHEDULE {Complete end ~nter total ~/A t below) <br /> <br />A, Residential Per Uni~ <br /> Service Included: <br /> <br />1000 aq, ft. or less <br />Each aSdk}onal 500 sq. it, <br />or potion ~hemof $15.00 <br />Limited Energy $20.00 <br />Each Manufd Iieme or M~lular <br />Dwelling Sendcc or Feeder $40.00 <br /> <br />B. Servic,~ or Feeders (Does not inlcude branch cirettits, see ~eetion D) <br /> <br />$85.00 4 <br /> <br /> Installation, Alterations or Relocation <br /> 50.00 <br /> 200 amps or le$~ <br /> 201 ~trnps to 400 amp~ ~ __ 2 <br /> 401 amps to 600 amps <br /> 6(11 amps to IIX)() amps $t30,00 ..... 2 <br /> Over 1000 ampa or vok~ $300,00 <br /> R~conneet oQly <br /> <br />C, Temporary ServlcedFeeders <br />Installation, Alteration, or RdOeafio~ <br />200 amps or less $35.00 <br />201 amps to 400 amps $40,00 2 <br />401 :a'nps to 600 amps <br />Over 600 amps or 1000 volts <br /> <br />13, Branch CimultS <br /> New, Alteration, or Extension Per Panel <br /> <br /> a)The fee for branch ¢imalts with <br /> purchage 9~ $~rv~ C~ 9~ ~cedcr <br /> <br /> b) The fe~/or branch ~rout~ ~ <br /> First brarteh circuit / $35,00 ~'~'~ <br /> Each additional br~nch circuit <br /> <br /> ~aeh pump o~ ir~gat/~l circle $40,00 __ 2 <br /> HaO1 d~n or oudme l/ghling Sd0,00 <br /> Signal c/rcuit(s) or a Iinliled energy <br /> panel, alteration or extension ~ $40.00 -- 2 <br /> <br />E, Each additional lnsp~tlon <br />over the allowable in any of the <br />above, per In¢i~mtlon ~ $35.00 <br /> <br />G, Minor Installation Labtl$ <br /> Pack of 10 labels @ $5.00 each _, $50.00 <br /> <br />FI. Other <br /> ( A~ required by Building <br /> <br />5. FEES <br /> <br /> A2. Agd 5% surcharge (.0~ x Al) <br /> <br /> Subtotal <br /> <br /> Fl. Eilt~r 25% of hne A 1 ~r Plan Review <br /> (Se.c. 3), if requir~ <br /> C. InvestigationFee (Lf mquircd) <br /> D, Reinspe. ction Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />Receipt No, <br /> <br /> <br />