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<br />fr- j?6?/f <br /> <br />FOR (}~ICE USE ONLY <br />Reêeived by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br />Salem, Oregon 97301 <br /> <br />Phone 588-51478:00 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 />C(lo- ~ ti ~ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WTI1IIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> <br />Electrical Contractor <br /> <br />Mailing Address <br /> <br />Property Owner <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Reg. No. <br /> <br />Supervisor's License No.. r- <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br />Mailing Address I Phone <br />City!State!Zip <br />The installation is being made on property I own which is not intended for sale, <br />lease, or rent. <br />Owner's Signature <br /> <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 />MC 15-3411/91 <br /> <br />SITE#: <br /> <br />Permit No. <br /> <br />Date: <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br />Number of Inspections per permit allowed l <br /> <br />Items Cost (each) Sum <br /> <br />A. Residential Per Unit <br />Service Included: <br /> <br />1000 s~. ft. or less $85.00 -4 <br />Each a ditional500 sq. ft. $15.00 <br />or portion thereof - <br />Limited Energy $20.00 - 1 <br />Each Manufd Home or Modular <br />Dwelling Service or Feeder $40.00 _2 <br /> <br />B. Services or Feeders (Does not inlcude branch circuits, see section D) <br />Installation, Alterations or Relocation I <br />200 amps or less --L.- $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 1000 amps $130.00 - 2 <br />Over 1000 amps or volts $300.00 - 2 <br />Reconnect only $40.00 - 2 <br /> <br />C. Temporary ServicesIFeeders <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 />$35.00 <br />$40.00 <br />$80.00 <br /> <br />_2 <br />_2 <br />_2 <br /> <br />D. Branch Circuits <br />New, Alteration, or Extension Per Panel <br /> <br />a) The fee for branch circuits ~ <br />Durchase of service or feeder fee <br /> <br />Each branch circuit <br /> <br />$2.00 <br /> <br />b) The fee for branch circuts without <br />ourchase of service or feeder fee <br /> <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.00 <br />$2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br />Each pump or irrigation circle $40.00 <br />Each sign or outline lighting $40.00 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 <br /> <br />F. Each additional Inspection <br />over the allowable in any of the <br />above, per Inspection <br /> <br />_2 <br />-2 <br />_2 <br /> <br />$35.00 <br /> <br />G. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each <br />(sold only to electrical contractors) <br /> <br />$50.00 <br /> <br />H. Other <br />( As required by Building Official) <br /> <br />5. FEES <br /> <br />A I. Enter total of fees from Sec. #4 <br />A2. Add 5% surcharge (.05 x AI) <br /> <br />$ .J-'i"O-OO <br />$ d..~)O <br />$ <br /> <br />Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br />(Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br />$.\,.1.<-)Q <br /> <br />Receipt No. <br />