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ONLY <br />Received b y .-~-/~/~ <br />Date: ~'~ ~'~'~.~O-~-~-- <br /> <br />i MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oxegon 97301 <br /> Phone 588-5147 8:00 am. 4:30pm <br /> Cod~-A-Phone: 585-7904 <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 />Olractinns <br /> <br />Descdpaon <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLlg AND <br />EXPIRE IF WORK IS NOT STARTED WlTI-IIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's Board Reg. No, I Job No, <br />Signature of Supc~MsJng Electrician <br />Supervisor's ~n~c No, I ~one No. <br /> <br />2B, FOR OWNER INb'rALLATIONS <br /> <br />Prol~c~y Owner <br /> <br />Mail, s Address <br /> <br />City~tate/Zip <br /> <br />The installation is being made on property ~ own whiO1 is no~ in .I '/reded for sal~, <br /> <br />3. PLAN REVIEW SECTION <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 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 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enar ~otal in A 1 I:ndow) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) Sum <br /> <br /> 1003 sq. ft. or less $8S .00 -- <br /> Each additional 500 sq. ft. <br /> or portion [bemof $1~.00 __ <br /> Limited ~ $90.00 <br />Eec ufd omc or Moduinr <br /> <br />B. S'er~ces or Feeders (Does not inlcude branch circuits, se* section <br /> Installation, Alterations or Relocation <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 6{)1 amps to 1000 amps <br /> <br />12. Temporary Servlees/F~ders <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 40lam sto6OOam s <br /> Over ~ amps or I~0 volts <br /> <br />D, Branch Cimnlts <br /> New~ Alteration or Extension Per Panel <br /> <br /> a) The fe~ for branch c~rcuhs with <br /> l~,r~gse,of se~Ace or feedor fee <br /> <br /> Each br~nch e~rcult <br /> <br /> b) The fe~ for branch civeut~ without <br /> lmmhax¢ of service of fe~0~ ~ <br /> <br /> First branch eircuk <br /> Bach additional branch cimuit <br /> <br />E. Mi~eellaneaua (Service or Feeder Not Included) <br /> tisch pump or irrigation circle <br /> Each sign or o~[line lighting <br /> Signal circuit(s) or a liffiil~d energy <br /> <br />F. Each additional Inspection <br /> above, per Inspeetlon <br /> <br />G, Minor Installation Labels <br /> Pack of 10 labels @ $5.00 ¢ach <br /> <br />H. Other <br /> ( As required by Builddig Offida0 <br /> <br />50.00 <br />~60.00 <br />$100,00 <br />$180.00 <br />$300,0o <br /> $40.00/'to <br /> <br />$85.00 <br />$40,00 <br />$80,00 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $~,0o <br /> <br />$40,00 <br />$40,00 <br /> <br />$40.00 <br /> <br />$85.00 <br /> <br />$~o.oo <br /> <br />5. FEES <br /> A I. Enter total of fens from Sec. #4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enlcr 2-5% of line A1 for Plan Review <br /> (S¢¢, 3), if mquireal <br /> C.D~R~i~I~: Investigation. ~:~ Fee ~. ~'w (ff ~_.~. rea~ired)~.~/~ . <br /> <br /> TOTAL AMOUN~ DUE <br /> Receipt No. ~¢~/~ g '~'~ <br /> <br /> <br />