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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ail Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION S'akxa, Oregon 97301 {~ L~, ~ <br /> Phc~ 588-5147 8::~ ~ - 4;;3~ l~ ~ ~ { ~ <br /> <br /> ~c-A-~: 588-7~n SiTE~,, ~ ~ ]~ Permit No <br /> ~AX: 5~-794~ <br /> <br /> CUtL~G INSPECTION <br /> Issueo Dy: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE l~ WORK IS NOT STARTED WTTHIN 180 DAYS OF ISSUANCt] <br />OR IF WORK IS SUSPENDED FOR 1 $0 DAYS.. <br /> <br />4. FEE SCHEDULE (Complete and enter total ~n A I below) <br /> Number of Inspections per permit allowed ~ <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> / <br /> <br /> Installation, Alterations or Relllga:ffim ~'O ~-- <br /> 200 amps or less r~ .~ ?/,, / $5000 .,~t 2 <br /> 20] amg~ to 400 aml~s'On~ I lb~'/ , $6000 2 <br /> 401 ami~ to 600 ~m~a/- ~ .... $100,00 2 <br /> 601 amps to 1000 am~ ~/D~/ $130,00 2 <br /> Over 1000 amps or volt~ 0' $30000 2 <br /> <br />Con,ractof, goard Rep. No.. ?7 } Job No. <br /> <br />2B, FOR OWNER iNSTALLATIONS <br />F'mper~y Owner <br />Marling Address Phone~ <br />Cay/St atcffJp <br /> <br />The b~stMhfion ia I~mg made on p~perty I own wI~ich is nO~ intended for <br /> <br />Owners Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan rev/ow service if ~ou complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application, <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br />MC 15.34 ]1/91 <br /> <br /> $4O O0 __ <br /> <br />C. Temporary Servic~'eeders <br />Installation, Alteration, or Relocation <br />200 amps or less ...... $35,00 __ 2 <br />201 m~p~ to ~00 ampa $4O00 <br /> 401 ~ps to ~ ampa ~ $8000 <br /> ~r ~ ~ps or 1~ volt~ <br /> <br />D. Branch <br /> <br /> a) %c ~ ~or ~anch ~rcMts ~ <br /> <br /> b> ~ f~ for ~ch drcat$ ~ <br /> Each ad~fi~ ~ch circuit <br /> Eneh si~ or ou~ne l~h~g $4000 ... <br /> <br /> Pack ~ 10 lulls ~ $5..~ aa~ .. <br /> <br />H+ ~her <br /> (As mqu~red ~ BumMing <br /> <br />5. FEES <br /> Al. Enter total of f*¢s from Sac #4 <br /> A2. Add 5% surcharge (05 x Al) <br /> <br /> Subtotal <br /> <br /> R Entre%off. A1 for~nRcvicw <br /> (S~ 3), if mq~r~ <br /> <br /> D Rcin5~c~ Fee <br /> <br /> ~L AMO~ DUE <br /> <br />$ <br />$__ <br />$ <br />$~-- <br /> <br /> <br />