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FOR OFFICE USE ONLY *' 220 High Street NE Received by:. Salem, Oregon 97301 Date: Phone 588-5147 8:00 ~n - 4:30pm Code-A-Phone: 588-7904 FAX: 588-7948 ELECTRICAL PERMIT APPLICATION ' I I Please complete all Sections, I through 5 MARION COUNTY BUILDING INSPECTION SITE #: Date: Issued by: Permit No. 1. LOCATION OF INSTALLATION ,ohAdd.s, 3-3o c_ I esT PA b T-r iT- I Description PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK IS NOT STARTED ~ 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. :ZA. CONTRACTOR INSTALLATION ONLY Property Owner Phone Contractor's License No. Contractor's Board Reg. No. Signature of Supervising 2B. FOR OWNER INSTALLATIONS Pmpany Owner Mailing Address I Phone 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 fighting 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 A1 below) A. Residential Per Unit Service Included: Number of Inspections pea- permit allowed --~ 1 Iterns Coat (each) Sum/ 1000 sq. ft. or less $85.00 ~. 4 Each additional 500 sq. ft. or portion thereof $15.00 Limited Energy $20.00 Each Manufd Home or Medular Dwelling Service or Feeder $40.00 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 $50.00 __ 2 401 amps to 600 amps $100.00 ~ 2 601 amps tu 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 $35.00 201 amps to 400 amps $40.00 401 amps to 600 amps $80.00 Over 600 amps or 1000 volts S~ "B" above D. Branch Circuits New, Alteration, or Extension Per Panel a) The fee for branch circuits wi~ purchase of service or feeder fee Each branch circuit $2.00 b)The fee for branch circuts without purchase of service or feeder fee First branch circuit $35.00 Each additional branch ch'cuit $2.00 E. Miscellaneous (Service or Feeder Not Included) Each pump or irrigation circle $40.00 Each sign or outline lighting $40.00 Signal circuit(s) or a limited energy panel, alteration or extension $40.00 F. Each additional Inspection over the allowable in any of the above, per Inspection $35.00 G. Minor Installation Labels Pack of 10 labels @ $5.00 each $50.00 (sold only to electrical contractors) H. Other (As required by Building Official) I 5. FEES Al. Enter total of fees from Sec. #4 A2. Add 5% surcharge (.05 xA1) Subtotal B. Enter 25% of line A1 for Plan Review (See. 3), if required C. InvestigationFee (if required) D. Reinspaction Fee ($25.00) TOTAL AMOUNT DUE Receipt No. $ zF"- $ $ $ $ VT, z(