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FOR OFFICE USE ONLY <br />Received I~y: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />Date: <br /> MARION <br />Issued ._ ....... ,,, <br /> bY' i~UiLi. Jii~~ .,,,.n ....... <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />~sc6p~on <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br />Mailing Address I Phone <br />City/State/Zip <br /> <br />The installation is being made on property I own which is not intended for sale, <br />lease, or rent. <br /> <br />Owners Signature __ <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 Code, Chapter 53. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number of Inspections per permit allowed q <br />A. <br /> Residential <br /> Per <br /> Unit <br /> / <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> lO00sq, fz. orless .. $85.00 ~ 4 <br /> Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br /> Limited Energy $20.00 ~ 1 <br /> Each Manufd Home or Modular <br /> Dwelling Servic~ or Feeder $40.00 ~ 2 <br /> <br />Bo <br /> <br />Services or Feeders (Does not inlcude branch circuitL see section D) <br />Installation, Alterations or Relocation <br /> 200 amps or less $50.00 2 <br /> 201 amps to 400 amps $60.00 2 <br /> 401 amps to 600 arnps $100.00 __ 2 <br /> 601 amps tO 1000 amps $130.00 2 <br /> Over 1000 amps or vol~ $300.00 2 <br /> Reconnect only $40.00 2 <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 volts <br /> see "B" above <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Pane! <br /> <br /> a) The foe for branch circmts ~ <br /> purchase of servi .c~. or feeder fee <br /> <br /> Each branch circuit <br /> <br /> b) The fee for branch circuts without <br /> purchase, o_f sctYice or feeder fee <br /> First branch circuit ""~ <br /> Each additional branch circuit ~ <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irrigation circle <br /> Each sign or ontline hghting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension <br /> <br />E Each additional Inspection <br /> over the a/lowable in any of the <br /> above, per Inspection <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5,00 each <br /> (sold only to electrical contractors) <br /> <br />Il. Other <br /> (As required by Building OfficiaO <br /> <br />$35.00 . 2 <br />$40.00 _ 2 <br />$80.00 ~2 <br /> <br />$ s.00 q6 <br /> SZOO <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 . . <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 $ <br /> A2. Add 5% surcharge (.05 x Al) $ <br /> S-bto al $ qc .' b <br /> <br /> B. Enter 25% of hne A1 for Plan Review <br /> (Sec. 3), if required $ <br /> C. InvestigationFee (ff required) $ __ <br /> D. Reinspection Fee ($25.00) $ <br /> <br /> To'rat. AMOUNT DUE <br /> <br />MC 15-34 11/91 Receipt.No. <br /> <br /> <br />