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FOI~ O~I~CE USE ONLY Received by:. Date: Salem, Oregon 97301 Ic~''~ ~ Phone 588-$147 8:00 am- 4:30pm q~) Code-A-Phone: 588-7904 '"' FAX: 588-7948 ELECTRICAL PERMIT APPLICATION P/ease complete all Sections, I through 5 I MARION COUNTY BUILDING INSPECTION 285 Church St. NE - Room 132 SITE ;~1~ ..... .;eA'~ Na,,,~,~ j/..! i~i o, f3,.~ Date: .... ,^,, t,~t~l IMTV ~I~D. IU01 uuu,,~ ~ , Issued by:BIJ![131NG INSPECTION 1. LOCATION OF INSTALLATION Jo ,Address /Oq '7 ' uHe_. ,.Yr. Directions PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK IS NOT STARTED WITItlN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY Electrical Contractor ~; I~YY,//lle./-Z~"-~'((-10~h°ne ~9~;~,~ .o',~,L~ ~ Mailing Address ,~ ~X ',..~/"~ /.~'~V;/t(~, qTO7D ../ con, ctoes Conmcto[s Board Reg. No. ~4~q I l{ Su~msors Umnse No. l~C3~ {~ - ] Phone No.~ ne No.~.,9~ [~ 4. FEE SCHEDULE (Complete and enter total in A1 below) Number of Inspections per permit allowed --~ A. Residential Per Unit 1 Service Included: Items Cost (each) Suml 1000 sq. ft. or less $85.00 ~ 4 Each additional 500 sq. ft. or pollJon thereof $15.00 Limited Energy $20.00 1 Each Manufd Home or Modular Dwelling Sen, ice or Feeder $40.00 ~ 2B. FOR OWNER INSTALLATIONS Property Owner Mailing Address City/State/Zip IPhone 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 8/94 Bo Services or Feeders (Does not inlcude branch circuits, see section D) Installation, AIt~ations 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 10OO amps $130.00 ~ 2 Over loo0 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 fee Each branch circuit b) The fee for branch circuts .wi .thout 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 . ~. F. 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 Budding Official) $35.00 ~2 $40.00 ~2 $80.00 2 $2.00 $35.00 $2.oo $40.00 ~ 2 $40.00 ~ 2 $40.00 High, $35.00 $50.00 5. FEES Al. Enter total of fees from Sec. #4 A2. Add 5% surcharge (.05 x Al) Subtotal B. Enter 25% of lLne A1 for Plan Review (Sec. 3), if required C. Investigation Fee (ff required) D. Reinspection Fee ($25.00) TOTAL AMOUNT DUE Receipt No. $ $ $ $ $ '9