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FOR OFFICE USE ONLY <br />Received by: <br />Date: ' <br /> <br />MARION COU~NTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $$$-5147 g:00 am - ¢:30pm <br /> Coae-A-Phor~; 588-79O4 <br /> FAX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />Date: <br /> <br />Issued by: <br /> <br />PermitNo. <br /> <br />1. LOCATION OtelNSTALLATION <br /> <br />PERMITS ARE NON -TP. ANSFERABLll AND NON-REFUNDABLE ANT) <br />EXPiRE IF WORK IS NOT STARTED W1TlqlN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRA~FOR IN~I'ALLATION ONLY <br />Ele~tdcalC°nt~[ZER ELECTRIC IN~-h°ne 378-0267 <br />Mailing Add.ss <br /> <br />Prol~ay Owner } Phone <br /> <br />Contractog~ <br /> Board <br /> No. <br /> No, <br />Signate r~ of Surmising El~tfieian ~~[~ <br />Sup¢mis~,r'¢MmnseNo, ,, 28438 ~pho <br /> <br /> FOR OWNER INSTALLATIONE <br />Prope~.y Owner <br /> <br />Ma/llng Address Phone <br />City/gtate/'Z/p <br /> <br />'llae installafioa is being made on pmpurty I own which is not intandod for sale, <br /> <br />3, Iq,AN REVIEW SEC/I~ION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications Mth <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power c~dculations, plans. <br />and spc, ci[ications when required by the Oregon Structural <br />Specially Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />A. Residential Per Unit <br /> Service Included: <br /> <br /> ~000 sq, fl. or loss <br />Each aAdi~l:d 500 sq. A. <br /> or po~cm thereof <br />Limited Energy <br /> <br />$85.00 ~ 4 <br /> <br />$18,00 <br />$20,00 ~ 1 <br /> <br />Each Manuf d Home or Modular <br /> Dwelling $em~ or Feeder <br /> <br /> $40,00 <br />Services or F~xl~rs (Dcms not ~atcude branch ¢i fcuits, see sec¢on D) <br /> <br /> Installation, Alterations or Relocation <br /> 200 amps or less <br /> 201 arapa to 400 <br /> 401 amps to 600 amps <br /> 6el am~ps~to 1000 amps <br /> Over I000 $mps or vokq <br /> Rex~Z, nneet only <br /> <br />C, Temporary Services/Feeders <br /> InstaSaOon~ Alteralio~l~ or Relocation <br /> 200 amps or less <br /> 201 .Pcfips to 400 anlps <br /> 40I alllpS [o 600 amps <br /> Over 600 amps or 1000 volts <br /> see "B" above <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) Thc; fee for branch e..iretlits ~ <br /> tmreha.~e, of se~c'e 9r feeder fee <br /> <br /> Each branch clmuk <br /> <br /> b) The fe~ for branch Circuts ~ <br /> gsrehase of service or feeder fe~ <br /> <br /> Each additional branch oircuit <br /> <br />E. Nliseetlltueou~ (Service or FeoMrer Not Included) <br /> Each pump or irrigation ¢i~d~ ...... <br /> Each sign or outline lighting <br /> Signal ¢ireuil{s) or a limited <br /> <br />F. Each additional Inspection <br /> over the allowable in any of the <br /> above, per inspection <br /> <br />G. MinOr Installation Labels <br /> Pack of 10 labels @ $5.00 each <br /> <br />H. Other <br /> (As mqtdred by Building Official) <br /> <br />2 <br /> <br />$80,00 <br />$6o,0o <br />$100.00 ~ 2 <br />$130.00 ~ 2 <br />$300,00 __ 2 <br />$40.00 __ 2 <br /> <br />$35.00 , 2 <br />$40.00 , 2 <br />$80.00 __2 <br /> <br />$2.00 <br /> <br />$88.o0 <br /> $2.00 <br /> <br />$40.00 2 <br />$40.00 --2 <br /> <br />$40.00 .2 <br /> <br />$35.00 <br /> <br />$~.0o <br /> <br />5. FEES <br />Al, Enter total of fees from Sec. #4 $ ~. <br />A2. Add 5% snrcharge (.05 x Al) $__/ , ! 2~ <br /> <br /> Subtotal $ .... <br /> <br /> g. Enler 25% Of line A1 for l:'lan Review <br /> (Sec, 3), if required $ __ <br /> C. Inve.~tigationFoe (ff mquired) $ <br /> D. Reinspe¢fion Fee ($25.00) <br /> <br /> 'IDTAL AMOUNT DUE <br /> <br /> Receipt No. _, <br /> <br /> <br />