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FOR OFFICE USE ONLY <br />Received <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 completo all Soctions, I through 5 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />.Pro.ny Owner - [Ph <br /> <br />Si~natuw o}Su~is~g El~tfician ~ <br /> ¢ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Marling Address I Phone <br /> <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 />Owner's 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 A1 below) <br /> <br />A. Residential Per Unit <br /> Service Included: <br /> <br />Number of Inspections per permit allowed <br /> <br /> Items Cost (each) Sum/ <br /> <br /> $85.00 4 <br />1000 sq. ft or less <br />Each additional 500 sq. ft. <br />or portion thereof $15.00 <br />Limited Energy $20.00 . 1 <br /> <br />Each Manufd Home or Modular <br /> <br />Bo <br /> <br />Dwelling Service or Feeder <br /> <br />$40.00 2 <br /> <br />Services or Feeders (Does not inlcude branch circuits, see section D) ~ <br />Installation, Alterations or Relocation / (--'O/ <br /> 200 amps or less t $50.00 ~ 2 <br /> 201 amps to 400 amps $60.00 ~ 2 <br /> 401 amps to 600 amps $100.00 ~ 2 <br /> 601 amps to lO00 amps $1~0.00 ~ 2 <br /> Over 1000 amps or volts $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 Panel <br /> <br /> a) The fee for branch circuits with <br /> purchase of service or feeder fee <br /> <br /> Each branch circuit <br /> <br /> b) The fee for branch circuts without <br /> purchase of service or feeder fee <br /> <br /> First branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension <br /> <br />E Each additional Inspection <br /> over the allowable 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 />H. Other <br /> (As required by Building Official) <br /> <br />$35.00 ~ 2 <br />$40.00 <br />$80.00 __2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.0o <br /> <br />$40.00 ~2 <br />$40.00 ~2 <br /> <br />$40.00 ~2 <br /> <br />$35.00 <br /> <br />SSO.OO <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br /> C. InvesfigationFee (if required) <br /> D. Reinspecfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br />MC 15-34 I1/91 i <br /> <br /> <br />