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FOR OFFICE USE ONLY <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Snlem, Oregon 97301 <br /> <br /> Phone 588-5147 8.'00 mn - 4'.30pm <br /> Code-A-Phone: $$8-7904 <br /> <br />IELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5- <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dil~ct[~t$ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFONDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. ~ <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing.Address '[~_~ <br /> ]Phono~ <br />eontnc~, U~ No. <br />~, s~ ~g. No. ~l I ~ ( J ~°- <br />s~,u~o, q ~ ~ ~N~~ <br /> <br />2B. FOR OWNER INS'~ALLATIONS <br /> <br /> Add~s [ ~e <br /> I <br /> <br />C~ty~tate~p <br /> <br />The instaHatio~ is .being made Ga properly I own wMch is not intended for sale, <br />lease, <br /> <br />Ownei's Sigmmm <br /> <br /> PLAN REVlKW SECTION <br /> <br />We will provide plnn review service if you complete Section - <br />5B nnd submit two (2) sets of plans and specifications with <br />this applicntion. <br /> <br />This optional plan review pro, ram does not suspend tho <br />required sutxnission of lighting power cnlculations, plans, <br />end specifications when required by the Oregon Stmctm-al <br />Specialty Code. Chapter 53. <br /> <br />MC 15-34 111~1 <br /> <br /> SITE #: <br /> <br />' Date: <br /> Issued by: <br /> <br /> HA o .d996 <br /> MARION COUNTY <br />BUILDING INSY~b t lure <br /> <br />4. FEE SCHE~UL~ (Cemldete md e~'---total h Al below) <br /> <br /> / <br />A. Reddeatld Per Unit' ' ' - ' <br /> Ser~eladuded: . "'.Items ' Cost (e.~ch) · Sum I <br />1000 sq. fL or lees , $85.00 4 <br />Each additynal..~0 s9. ft. <br /> m thereof $15.00 . , <br /> M~'~l~ome---,- or Modular ..., $ 20.00 . 1 <br /> <br />B. Services or Yeedem (Does not inlcude branch circuits, see sec~on D) <br /> Instalhtion~ Alterations or Rdoeatlon <br /> <br /> 201 amps to 400 amps <br /> 401 amlx to 600 amps $100.00 <br /> <br /> lnslallaflon~ Alteration~ or Rdo~a~on <br /> <br /> Over 6(X) amps or 1000 vohs <br /> see 'B" a~c <br /> <br />D. Branch Clmu~ <br /> New, Alteration, o~ E~tension Per Panel <br /> <br /> a) The fee for branch circulu wi~ <br /> purchase of se~ce or feeder f~ <br /> <br /> Each branch circuit $2.00 <br /> <br /> b) The fee for branch clrcuts Without <br /> _vurcha~e of service or feeder <br /> <br /> F'~t branch circuit $35.00 <br /> Each additional branch circuit $2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not In¢ludtd) <br /> Each pump or irdgafien circle $40.00 <br /> Each sign or eutlim lighting . $40.00 <br /> Signal cinmit(s) or a limited e~ergy <br /> panel, alteration or extmsio~ ~ $40.00 <br /> <br />F. Each additional Inspection ' <br /> over the allowable in any of the <br /> <br />G. Minm' Installation Label~ <br /> Pack of 10 labels ~ $5.00 each $50.00 <br /> (#oM only to electrical contractor#) <br /> <br />H. Other <br /> (As ~,d~ed by Buildi~S O~c~al) <br /> <br /> 2 <br />. 2 <br /> <br /> 2 <br />.2 <br /> <br />5. FEES <br /> Al. Eater ~ of fees from Sec #4 <br /> A2. Add 5% surcha~c (.05 x Al) ', <br /> <br /> Subtotal <br /> <br /> B, Enter25% of lineAl for Plan Revlew <br /> (Sec. 3), if <br /> c tnves~ion Fee 6f <br /> o. Reinspe~on Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />