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MARION COUNTY BUILDING INSPECTION <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />LOCATION OF INSTALLK~'ION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 $:00 am - 4;30pm <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br /> m <br /> <br />PERMITS ARE NON-TRAi~$FERABLE A2WD NON-REFLrNDABLI~ AND <br />EX'F~E IF WORK IS NOT STARTED WITHIN 150 DAYS OF ISSUANCE <br />OR iP WORK IS SUSPENDED FOR 1 S0 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />FAe~rieal <br /> Contractor I Phone <br />Marling Add.ss <br /> <br />p:~,x~rcy Owner I/~nc <br /> <br />Contractors Board Rcg. No, <br /> <br />{Job No. <br /> <br />Signature of Supcrcjslng El~[rle..ian <br /> <br />tPhone No, <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />1 he m~talauon xs ~g mad~ ~ p~ay I o u w~ ~s a~ m~nded ~or saI~, <br /> <br />Owne?s $ignatu~ 3 <br />,, - , ....- <br />PLAN REVIEW SE~TIO~ ~ <br /> <br />Wc will provide phm review service il' you complete S¢¢tioil <br />5B and submit two (2) sets of plans and spegifications with <br />this application. <br /> <br />This optional plan review program does not suspend thc <br />czquir.ed submission of lighting power calculations, plans, <br />and spC~ificatlons when required by the Oregon Struetta'al <br />Specialty Code, Chapter 53, <br /> <br />MC 15-34 11/9] <br /> <br /> Issued by: ,~iLO\~B ~,~o, ~ <br /> <br />4. FEE SCHEDULE (Complete/md eBtcr total m A l bclow) <br /> <br />R~identlal <br /> Unit <br /> <br /> or po~liO~ thereof __ $15,00 <br /> <br />Ba~h Manm°d Home or Modalat <br />Dwelling Scr¢;_c~ or Feeder ~ $40,00 <br /> <br /> Installation, AIt~ratlons or Relocation <br /> 200 81llps or lass <br /> 201 amps to 4~ amps <br /> ~1 a~ps to 6~ amps <br /> ~l a~ ~ 1~0 amps <br /> <br />C. ~m~rary ServJce~d~s <br /> <br /> 401 ~ps to ~0 <br /> <br />D, g~anch <br /> <br /> ~) The f~ ~or ~aoah 6reCta <br /> purchase of ~ or fe~e~,~e~ <br /> <br /> Each b~ch ci~uit <br /> <br /> b) ~ f~ fo~ bra,cb ~rcm~ ~ <br /> <br />E. MIscellan~us (Service or Feeder Not Included) <br /> Hath ~mp ~ i~ga6~ ~ec]e <br /> ~ach sign or oa~e l~h~g <br /> Signal ci~uit(s) o~ ~ ~itcd cncxgy <br /> <br />G. Minor Ins~llaflon La~ls <br /> Pack of 10 la~ls ~ $5.00 <br /> (sold oMy to electrical aontractor~) <br /> <br />H. Olher <br /> (As ~quired by Building <br /> <br />$60.00 <br />$100.00 <br />$130,00 <br />$300,00 <br />$40.00 <br /> <br />$35.00 <br />$40,00 <br />$80,00 <br /> <br />$2.00 <br /> <br />$35,00 <br /> $2,00 <br /> <br />$40,00 <br />$40.00 ..... 2 <br /> <br />$40,00 --2 <br /> <br />$50,00 <br /> <br /> 5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> AZ. Add 5% surcharge (.05 x A 1) <br /> <br /> Subtotal <br /> <br /> B. Enter ~$% of linc A l for Plao Review <br /> ($CC. 3), if rccluir c~ <br /> C. Investigation [:cc (if required) <br /> D, Rclnspecfic~l Fee ($25,00) <br /> <br />,, Receipt No, ~, [ <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />