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FOR OFFICE USE ONLY
<br />
<br />Received by:
<br />Date:
<br />
<br /> ELECTRICAL PERMIT APPLICATI~1Ii
<br /> Please complete all sections, I through 5
<br />
<br />1, LOCATION OF INSTALLATION
<br />
<br />cig ~r~, ~4 ~ ~, l ~: C-/,~ [cros= sc
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />
<br /> 220 High Street NE
<br /> Salem, Oregon 97301
<br />
<br /> mpe~588~-5147 $:00 ,sun - 4:~g)pm
<br />
<br /> Al~¥ I~ I~ ~ Is~by:
<br />
<br /> MARION
<br />BUILDING
<br />
<br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND
<br />EXPIRE IF WORK IS NOT STARTED wrlIHN 180 DAYS OF ISSUANCE
<br />OR IF WORK IS SUSPENDED FOR 180 DAYS.
<br />
<br />2A. CONTRACTOR INSTALLATION ONLY
<br />
<br />No. I C
<br />
<br />2B. FOR OWNER INSTALLATIONS
<br />
<br />Properly Owner
<br />Ma/ling Address
<br />
<br />Thc instalhfion is being
<br />
<br />Own~s Signature
<br />
<br />3. PLAN REVIEW SEC
<br />
<br /> . .,... . ,.,:;~:, :, '..; ,. ~: . , '
<br />We will provide 1: -. ......... .~:~. , :,~,.~,',,~..,..--:- : ....... ' ........
<br />· 5B nnd submit tw .'.'. ' ..,,,'." :.',-,.. T.' ?. :.'.:.. ::.,..c..: :' .. ..
<br />~is application. ' '"" ' ....... '"" :""'::'~" TM """* ~:'*"*"*': ' ' ' ' '
<br />
<br />This optional plat " ........ , .: ..v. .......
<br />required submissi "..., ':. ..'.', ' :.. ",. ":
<br />and specifications v~flcn ~qu,reo o~ mc cn-egon Structural I !
<br />Specialty Code, Chapter 53.
<br />
<br />MC 15-34 11/91
<br />
<br />Permit No.
<br />
<br /> Number of Inspections per permit allowed ==1
<br />
<br />A.
<br /> Unit
<br /> /
<br /> Sorvlee Included: It~ns Cost (each) Sum/
<br />
<br />1000 sq, fi. ~'less $85.00 4
<br /> .of $=o.oo $ S.oo
<br />Each ManufcTI-Iomc or Modular
<br />
<br />B. Services or Feeders (Doe= not inlcude branch circuits, see section D)
<br />
<br /> Instailaflot~ Alterations or Rdo?tion
<br /> 200 mpa. less $6000S50:00 . 2
<br /> 201 aml~ to 400 amps 2
<br /> 401 aml~ to 600 amps $100.00 2
<br /> 601 amps to 1000 an~ $130.00 2
<br /> Over 1000 amps or vohs $300.00 2
<br /> Recotmect only $40.00 2
<br />
<br /> Installation, Alteration, or Rdocatlon
<br /> 200 amps or loss $35.00 2
<br /> 201 amps to 400 amps $40.00 2
<br /> 401 amps to 600 amps $80.00 2
<br /> Over 600 amps or 1000 volts
<br /> see "B" above
<br />
<br />D. Branch Circuits
<br /> New, Alteration, or Extension Per Panet
<br />
<br /> a) Tbe fee fos brmch drcuits whh
<br />
<br /> Each branch citcuit $2.00
<br /> b) The fee los branch circuts withcut
<br />
<br /> Each additional branch chctdt $2.00
<br />
<br />E. Miscellaneous (Service or Feeder Not lnduded)
<br /> Each pump o~ irrigation circle $40.00 2
<br /> Each sign or outline Ughting $40.00 2
<br /> Signal circuit(s) of ~ Umit~d energy
<br /> panel, alteration os extrusion $40.00 .. 2
<br />
<br />F. Each additional InspecUon
<br /> over the allowable in any of the
<br />
<br />G. Minor InstallaUon Labels
<br /> Pack of 10 labels @ $5.00 each $50.00
<br /> (sold only ~o electr~cnl contractors)
<br />
<br />H. Other
<br /> (As reqaired by B~,iJdhtg O~c;,,l)
<br />
<br />5. FEES
<br />Al. Enter total of fecs from Sec. #4 $ ~ ~- o_==?
<br /> A2. Add 5% surcharge (.05 xAl) $ t ,"~t'-
<br /> $ 36, T~-
<br />
<br /> B. Hnter25% of lineAl for Plan Review
<br /> (sec. 3),if requi~d $
<br /> C. hvcstigation Fee (if required) $
<br /> D. Reinspectim Fee ($25.00) $
<br /> TOTALAIVIOUNT DUE $ 3 ~, -/'''~-~
<br /> Receipt No..
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