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FOR-OFFICE USE ONLY <br />Received by:. <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION" <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street ~NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8.~0 mn - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: ~ss-7948 SITE #: <br /> <br />OO1. <br /> <br />Permit No. <br /> <br />Da~e: <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Descfii~on <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IP WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR l~ WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />lVlailing Address J <br /> I <br /> <br />City/State/Zip <br /> <br />The installation is being made on propewj I own which is net intended for sale, <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 />~ffC i5-34 11/91 <br /> <br />· 4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> Number of Inspections i~r i~mit aimed .--~ <br /> l <br />A. <br /> Residential <br /> Unit <br /> Service Included: ~tams Co~t (each) Sum/ <br /> 1000 sq. fi. or less $85.00 4 <br /> Each additional 500 sq. ft <br /> or potion thereof $15.00 <br /> <br /> Each Manuf'd Home or Modular <br /> Dwelling Setviee or l:~eedm' ~.0.00 ~ 2 <br /> <br /> B. S~vlees or Feeders (Does not inloude branch drcuits, see section D) <br /> <br /> _ Instalhtion~ Alterations ot Relocation <br /> 200 amlx or less <br /> 201 am~ to 400 amps <br /> 401 raps to 6(X} ~am~ <br /> ~01 amps to 1000 amps <br /> Over 1000 mnps or volts <br /> <br />~'-.,1~ ter,~t~.o~'_ .Rdocaflon <br /> 200 amps orless K FYJD~5~ I $35.00 <br /> 201 amps to 400 ~ ' $40.00 <br /> 401 amps to 600 aml~ $80.00 <br /> . Over 600 amps or 1000 volts see "B" above <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch drouits with <br /> t~chase of service or feeder fee <br /> <br /> Each branch circuit $2.00 <br /> <br /> b)The fee for branch circuts wilhout <br /> _~rchase of sen, ice or feeder fee <br /> <br /> First branch circuit <br /> Each additional branch circuit $2.00 <br /> <br />~. Miscellaneous (Service or Feeder Not Induded) <br /> Each pump or irrigation circle ~.0.00 <br /> Each si~n or outline lighting $40.00 <br /> Signal chcuit(s) or a limited energy <br /> panel, alteration or extension $40.00 <br /> <br />F. Each additional Xnspection <br /> over Ihe allowable in any of lhe <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each ~50.00 <br /> (s~d o~/y to elec~cal contractors) <br /> <br />IL-Other <br /> (as ,~quZ,~d ~, Bv.Z~g <br /> <br />$100.00 2 <br />$130.00 2 <br />$300.00 2 <br />$40.0O 2 <br /> <br />,00 <br /> <br />5. FEES <br /> Al. Eater total of fees from Sec. #4 <br /> A2. Add 5% surcharge 605 xA1) <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee Ctf tequilA) <br /> D. Reinspecfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receilx No. <br /> <br />$ 35';. ~o_ <br />$ i <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />