Laserfiche WebLink
o ,,v I <br />Received by:_ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High S~reet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-plaone: 588-7904 <br /> FAX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />1. LOCATION OF INSTALLATION <br />,ohAdd,,,,, Il?o/t/ /I <br /> :,',.,.. I <br /> <br /> o6ov, <br /> <br />PrcJvrlTS AR]~ NON -'IRANsFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT S'IARTED W1TRIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR I g0 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br />Property Owner ' . Ph~e <br /> <br />Contractor's goard Reg. No. ~ ~ C/ {JobNo. <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner <br />Mailing Address Phone <br />City/State/Zip <br /> <br />The installation is being made on profmrty I own which is not intended for sale, <br /> <br />3- PLAN REVIEW SECTION <br /> <br />4, FEE SCHEDULE (Complete ~nd enter total io A 1 below) <br /> <br /> Nllltlber of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: tte~ls Coal (each) Sum <br /> <br /> 10O0 sq, fi, or less $85,00 <br /> Each a~ldifional 500 sq. ft. <br /> or trion thereof $18.00 <br /> $20.00 <br /> Each Manuf'd Ilome or Modular <br /> Dwelling Servic~ or Feeder $40.00 __ <br /> <br /> 200 amps or less $§0.00 <br /> 201 amps to 400 amps __ Se0.00 <br /> 401 amps to 600 amps <br /> <br />$100.00 <br />$180.00 <br />$300.00 <br /> $40,00 <br /> <br /> 601 am~p~s to 1000 amps <br /> <br /> 200 amps or less -- $35.00 <br /> 201 amps to 400 amps $40,00 <br /> 401 ~npx to 600 atlaps $80,00 <br /> <br />a) The fe~ for ~nch drcu[~ ~ <br /> pur~ase of sc~ ~ re,dry.fee <br /> <br />b) The f~ f~ bench drcms wi~out <br /> <br /> Pack ~ I0 la~s ~ $5.00 ea~ $50.00 <br /> ( A~ mqulred by B~iMi~g Offle~O ~ <br /> <br />__2 <br />__2 <br />__2 <br />__2 <br />__2 <br />__2 <br /> <br />__2 <br />__2 <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optioaal plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by tho Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />5. FEES <br /> A 1. J~ltet total of fees from See, #4 <br /> A2. Add 5% surcharge (.05 xAI) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of llne A 1 for Plan Review <br /> (Sec. 3), if required <br /> C. Inv~tigatlonFee (Lf required) <br /> D. Relnxpectlon Fee ('$25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. . .... <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />