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[ osIx <br /> Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />cOktmYmTY UEWLOPIVm~qT Eg~rt~R <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> Phc*ua 588-5147 8:00 ~- 4:3Opm <br /> Code-A-Phoae: 588-?~04 SITE <br /> #: <br /> FAX: 588-7948 <br /> <br />IELECTRICAL PERMITAPPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Dime. ions <br /> <br />PERMITS ARE NON-TRAI~FERABLB AND NON-REFUNDABLE AND' <br />EXPIRE IF WORK IS NOT STARTED WITH]IV 180 DAYS OF ISSUANCE <br />OR II: WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLy <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Ownar <br />Mail~g Address Phone <br />City/State/Zip <br /> <br />Th~ installation ts being made on property I own which is n~ intended for sale, <br /> <br />OwneFs Signatme <br /> <br />3. PLAN REVIEW SECT[ON <br /> <br />We will provide plan review service if ~ <br />5B and submit two (2) sets of <br />this application. <br /> <br />This optional plan review <br />required submission of Ii <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 8/94 <br /> <br />Date: <br /> <br />Permit No. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total ia Al below) <br /> Number of Inspections p~- permit allo~ed --] <br /> <br />A. <br /> ReMdengal <br /> Per <br /> Unit <br /> I <br /> Service Included: Items Cost (each) Sum/ <br /> <br />1000 sq. f~ ~' less $85.00 -- 4 <br />Each a~ldltiona1500 sq. f~ <br />.Ltm~g~ioa th*r~of $15.00 <br />Dwelling Servic~ or Feeder $40.00 ~ <br /> <br />B, Sertlces or Feeders (Ibis not inlcud~ bra~¢h *rcults, see section D) <br /> <br /> IasiallaUon, Alterations or Rd~x:aUon <br /> 200 amp~ o~ less <br /> 201 an~ps to 400 amps <br /> 401 amps to 600 amps <br /> <br /> p~a~_t t~lyPS or volts <br /> <br />C, Temporary Servicel/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 20! ~p~ to 4~0 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or 10~O volts <br /> s~ 'B" above <br /> <br />D. Branch CIrcuit~ <br /> N~w, Alteration, or Ext~l$1on Per Panel <br /> <br /> a) The fee for branc~ circuits ~ <br /> purchase of servloe or fe~ter fee <br /> <br /> Each branch circuit <br /> <br /> b) The fee for branch drcuts wit3out <br /> purchase of s~,'vine o~ feeder fee <br /> <br /> Fire branch circuit <br /> P~ach additional branch circuit <br /> <br />E. MIs~cllaneous (Service or Feeder Not Included) <br /> Each pmnp or ir~i,a~oa circle <br /> Each ~ign or outline I~ghting <br /> Signal circuit (s) or a limited euergy <br /> pmaal, alteration or exteudou <br /> <br />F. Each additional Inspection <br /> over the allowable in any of the <br /> above, per Inspection <br /> <br />O. Minor InstaEation Labels <br /> Pack of 10 labels @ $5.00 each <br /> (sold only to electrical conlractors) <br /> <br />H. Other <br /> (As required by Building Of~ciaO <br /> <br /> I50.00 2 <br /> 60.00 __ 2 <br />$100.00 -- 2 <br />$130.00 -- 2 <br />$300.00 -- 2 <br />$40.00 __ 2 <br /> <br />$35.00 __ 2 <br />$40.00 __ 2 <br />$80.00 __ 2 <br /> <br /> FEES <br /> <br /> Enter total of fees from Sec. #4 <br />A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />E. Enter 25% of [[ne Al for Plan Review <br /> (Sec. 3), if required <br /> <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />No. <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />$ <br />$ <br />$__ <br /> <br /> <br />