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FOR.OFFICE USE ONLY Received by: Date: MARION COUNTY BUILDING INSPECTION 220 High Street NE Salem, Oregon 97301 ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 5 Phone 588-5147 8:00 am - 4:30pm Code-A-Phone: 588-7904 FAX: 588-7948 :~X~ P~rmit~ SITE JAN - 2 199§ Date: MARIO COUNt · . ..... ~,~ i~on~Tl~M Issued bY.BuiLuuau n~o, 1. LOCATION OF INSTALLATION Description PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY Electrical Contractor MailingAddress ~toeg ~ 7~'~qI ~:~ t Property Owner~. i [ ~ I'~ ] L~.~s~_ Phone Contrac,o" Uc se Contractor's Board Reg. No. 3~7~~ JobNo. _ I Supe~iso~s ~nse No, /[~ ~V~one No. ' - I 2B. FOR O~ER INSTALLATIONS Property Owner Address [ Phone Mailing City/State/Zip The installation is being made on property I own which is not intended for sale, lease, or rent. Owner's Signature 3. PLAN REVIEW SECTION We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. This optional plan review program does not suspend the required submission of lighting power calculations, plans, and specifications when required by the Oregon Structural Specialty Code, Chapter 53. MC 15-34 11/91 4. FEE SCHEDULE (Complete and enter total in A 1 below) Number of Inspections per permit allowed -~ A. Residential Per Unit / Service Included: Items Cost (each) Sum/ $85.00 ~ 4 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $15.00 Limited Energy .. $20.00 1 Each Manufd Home or Modular Dwelling Service or Feeder $40.00 ~ 2 Bo Services or Feeders (Does not inlcude branch circuits, see section D) Installation, Alterations or Relocation 200 amps or less $50.00 2 201 amps to 400 amps $60.00 ~ 2 401 amps to6OOamps $100.00 ~ 2 601 amps to 1000 amps $130.00 ~ 2 Over 1000 amps or volts $300.00 2 Reconnect only $40.00 ~ 2 C. Temporary Services/Feeders Installation, Alteration, or Relocation 200 amps or less 201 amps to 400 amps 401 amps to 600 amps Over 600 amps or 1000 volts see "B" above D. Branch Circuits New, Alteration, or Extension Per Panel a) The fee for branch circuits with purchase of service or feeder fcc Each branch circuit b) The fee for branch circuts without purchase of service or feeder fee First branch circuit "'~ Each additional branch circuit ~ E. Miscellaneous (Service or Feeder Not Included) Each pump or irrigation circle Each sign or outline lighting Signal circuit(s) or a limited energy panel, alteration or extension E Each additional Inspection over the allowable in any of the above, per Inspection G. Minor Installation Labels Pack of 10 labels @ $5.00 each (sold only to electrical contractors) H. Other (As required by Building Official) $35.00 $40.00 $80.00 $2.00 $3 .oo $2.00 $40.00 ~2 $40.00 2 $40.00 ~2 $35.00 $5O.00 5. FEES Al. Enter total of fees from Sec. #4 $ A2. Add 5% surcharge (.05 x A 1) $ q; "Z~) Subtotal $ ~'~ .~ B. Enter 25% of line A1 for Plan Review (Sec. 3), if required $ C. Investigation Fee (ff required) $ D. Reinspecfion Fee ($25.00) $ TOTAL AMOUNT DUE $ Receipt No.