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J }-%omc uss oNLy <br />I Received by: ..... <br /> ~ Date: .~, ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMU'NITY DEVELOPMENT C~NTER <br /> 285 Chu~h St. NE - Room 132 <br /> Sak'm, O~goa 9730 l <br /> <br /> Phml, $~-5147 8:00 ~m - 4:30p~ <br /> Co~-A-Fa~e: 58S-7904 <br /> Fnx: 5ss-79~s SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ali Sections, 1 through 5 <br /> <br /> L LOCATION OF INSTALLATION <br /> <br />,, . .... <br /> <br /> .... u k'l~ <br /> <br /> ARE NON-TRANSF~'RABLE A]~D NON.R]~FUNDABL]] AND <br />~ WO~ IS NOT STATED ~ 180 DA~S OF ~SU~C~ <br /> <br />OR IF WORK I$ SUSPEND,2D FOR 150 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INffl?ALLATION$ <br /> <br />Property 0wller <br />Mai~g Address I Phone , <br /> <br />Chy/StatodZip i <br /> <br />The installafio~ is baing made on pro,fry I own which is flor inumded for sale. i <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We Mil provide plan review service if you complete Section <br /> 5/3 and submit two (2) sets of plans and specifications with <br /> this application_ <br /> <br /> 'This optional plan review program does not S~sl~nd the <br /> required submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapte~ 53. <br /> <br />MC 15-34 8/94 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total h~ A 1 b~low) <br /> <br /> Number of Inspections pel' permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> S~rvlce Included: Iteans Cost (each) Sum/ <br /> <br /> 1000 sq. ft ~ less $85.00 <br /> ~ach additional 500 sq. f~. <br /> or poaiee thcrcof $15,00 <br /> Limi~d Ene~g~ $~0,00 <br /> Each Manuf d Hom~ or Modular <br /> Dw~ng Ser4c~ or gaede~ ~ $40,00 <br /> <br />B. Ser~lees or F~ade~ (~es n~ ~lcu~e ~nch circuit, s~ seatio~ D) <br /> In~llallo~ Al~attons or Rd~aflon / <br /> <br /> ~r 1~ ~ps or volts $300.~ <br /> ~ect ~y $40,00 <br /> <br /> Ore,r, 600 amps or 1000 vohs <br /> <br /> a) Th~ f~ for bratlch <br /> <br /> b) The fee for brar~ch dreuts <br /> <br /> Each Immp or jrrlgatica c~rde <br /> Each sign or o~tli~ lightin$ <br /> Rignal e..ircuit(~) or a limlted energy <br /> <br />F. Each additional Inspection <br /> oveg thc ~Jlowabl~ in ~ny o~ the <br /> <br />G. Minor lns~allanon Labels <br /> Pack of 101 abe3s ~ $5.00 sach <br /> <br /> ( As required by Buildlng Official) <br /> <br />$36,00 <br />$4O,00 <br />$80,00 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$4O,00 . 2 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br />$. FEES <br /> Al. Enter total of fees f~'om S¢c, #4 <br /> A2, Add 5% sumhatge 605 x A 1 ) <br /> <br /> Subtotal <br /> <br /> B. Enter Z5% of llnc ~1 fo~ Plan <br /> (Sec. 3), if required <br /> C. Investigation Fcc (i/required) <br /> D. Reinspectlc~ Fee ($25.00) <br /> <br /> 'PDTAL AMOUNT <br /> Receipt No, , <br /> <br />$ 7S~ <br />$ .... g, qa,, <br /> <br /> <br />