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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Chttrc~ St, NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> Phon~ 588-5147 8:00 anm - 4:3Ogq~ <br /> Ca~-A~Ph~nu: 58S-7904 <br /> PAX: ~Sa-794S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />p EP~flTS ARE NON.TRANSFERABLE AND NON-REFUNDABLE ~ <br />EXPIRE IF WOKK IS NOT STARTED ~ lS0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDIgD FOR 180 DAYS. <br /> <br />2A, CONTRAL~I'OR INSTALLATION ONLY <br /> <br />Electrical Coutracqor ~ ,'/ _ ~ <br /> <br />Pm~ny Ow~r , <br /> <br />C~atrac~r'~ B~ ~g, No, <br /> <br />Signature of Supervising Ele~trlcian <br /> <br />SupevAsor's IAc.~se No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pto~r[y Owner <br /> <br />Mail/ns Address Irnone <br /> <br />City/St atdZip <br /> <br />The inst al~ation is beln8 made on prot~r ty I own which is ~ intended for gale. <br /> <br />PLAN REVIEW SECTION <br /> <br />We will provide plan re'dew service, if you complete Section <br />5B and submi£ two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review pwgram does not suspend the <br />required submission of lighting power calculations, plans, <br />and, specifications when required by the O~egon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 8/94 <br /> <br />Date: <br /> <br />PermitNo. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total i~ A I below) <br /> <br /> Number of Illspecttans per permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Uuit <br /> $eevlee Included: Ite~ns Cost (each) Sum/ <br /> 1000 sq. ft. or less $85.00 <br /> Each aa&~ioral 5~o s~l, f~, <br /> ~u,u,./,aa tremor $15.00 <br /> Limlte,1 l~nemv ..... 520.00 <br /> Rach Manutd ~ome or Modular <br /> Dv~ Sev.5o~ er Fe,~r SaO.O0 ~ <br /> <br />tL Ser*to~ or Feeders ['Docs not ~leude branch circultq, see section <br /> lwslallation, Alter atlon~ or Ralocatlrm <br /> 200 amps or less $50.00 ~ <br /> 201 amps W 4C0 amps ~ $$0,00 <br /> 401 amps to 600 amps <br /> 601 ~'nps to 1000 amp~ $180.00 ...... <br /> Over 1000ama)am s or volts $300.00 <br /> Reeonne¢[ o~y $40,00 __ <br /> <br /> C. Temlmrary $ervlors/Feeders <br /> Installation, All,m-alton, or Relocation <br /> 200 amps or less $35,00 .. , <br /> 201 ~nps to 400 amps $40.00 <br /> 40! amps to 600 amps 5~0,00 <br /> Over 600 snaps or I000 volts <br /> <br /> D. Branch Circuits <br /> <br /> a) Tim fee for branch circuits ~ <br /> purchase of servic~ or fccd~r <br /> <br /> Each trench circuit $2,00 <br /> b) The fee for branch cire~gs 3Fithout <br /> <br /> ~t branch cizcuit { $35.00 ~._~_ <br /> Each additional branch dteuit <br /> <br /> g. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or L~igafioa circle $40,00 <br /> Each aigm om ouglia~ lighting ., 540,00 <br /> Signal circuit(s) or a ILmit~d cncugy <br /> panel, dmration or extension $40,00 <br /> <br /> over the allowabl~ in any of th~ <br /> <br /> G. Minor Installation [.abels <br /> Pack of l0 ]abels@ $5.00 each ., 550,00 <br /> (sold onYy to electrical contractors) <br /> R. Other <br /> (As required by Building Official) <br /> <br /> s. 0L. qu1 <br /> A2. Add 5% surcharge (-05 x Al) 5 ~ '? .'> <br /> Subtotal 5 <br /> <br /> B, E~ter 25% of Eo~. A1 for Plan Review <br /> ($~e. 3), if required $ <br /> C. [nvesfigationgee (if require/l) $ <br /> D, Rt, inspe~fion F¢¢ ($25.00) $ <br /> TOTAL AMOUI'~ DUFe $ ~ <br /> <br /> <br />