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-,,' MARION COUNTY BUILDING INSPECTION <br />*' COMMUNITY DEVELOPMENT CENTER <br /> FOR CITY VALIDATION[ 285 Church StNE · Room 132 PERMIT NO: <br /> Received by: Salem, OR 97301 <br /> Date: ' ' · 588-7904 Dar0: <br /> <br /> ELECTRICAL PERMIT APPLICATION I ',I/I/V ! <br /> Pleasecomplete all Sections, I through 5 .... 4. FIII~ scmtDULB (Co~plcteana~r~oUaaAl belo~,) <br /> · I~ARION ~ UN[Y Nmnber°flnspecti°nsperpormitall°wed--'3 <br /> 1. LOCATION OF INSTALLATION BUILDINGIA )~/~d?tl.l Pe~ Unit <br /> t*~,ll~4~ lnoludmd: Items Cost (each) Sum I <br /> <br />D~¢riptio~~ ~ ~ <br /> <br />PERIVnTS ARE NON-TRANSFERABLE AND EXPIRE IF WORK lS NOT <br />STARTED v~rlTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OV~NBR INSTALLATIONS <br /> <br />Proporty Owner (pleas~print) <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIIIW $tlCTION <br /> <br />IMarion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />1000 sq. ft. or less $85.00 4 <br />Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br />L~mited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Sea'vioe or Feeder $40.00 2 <br /> <br />B. Servioea e~ Feeders (l)eea not in¢iode branch eimuita, see section D) <br /> lnatallation, Alteration or Relooation <br /> 200 ~nps or less ~__ $50.00 ~ <br /> 201 wnps to 400 ~nps $60.00 2 <br /> 401 traps to 600 amps $100.00 2 <br /> 601 wnps to 1000 traps $130.00 2 <br /> Ow, r 1000 ~nps or volts $300.00 :2 <br /> Reconnect only $40.00 2 <br /> <br />C. T~mp~xary 8ervkwlFeed~s <br /> <br /> 200 ~unps or tess $35.00 2 <br /> 201 amps to 400 amps $40.00 2 <br /> 401 am[~ to 600 amps $80.1)0 2 <br /> Over 600 amps or 1000 volts <br /> <br />D. Brznda Ciroui~ <br /> <br /> ~) Tn~ fee for branch circuits with <br /> pumh~c of ~erviee of feeder fee ~ <br /> Each branch eiecuit <br /> <br />b) The fee for branch cimuits wi0mut <br /> numha~e of service or feeder fee <br />First branch circu/t <br />Each additional branch circuit <br /> <br />n. Mineellaneou$ (5~viee ~r F~de~ Not l~l~d~) <br /> ~ch prop ~ i~gatbn cimle <br /> ~ch si~ or outline li~t~g <br /> <br /> ~er t~ allowable ~ any of~e <br /> <br />O. Min~ In~lhtion Labels <br /> Pack of 10 I~cls 0 $5.~ ~ch <br /> (~d onlyto elvc~i~l <br />H. Oth~ <br /> <br /> Arum Dwelling Elzvtrlcal F~ <br /> <br />$ 2.00 ~ [ <br /> <br />$35.00 <br />$ 2.00 <br /> <br />$35,00 -- <br />$50.00 <br /> <br /> ~q. lL x $.06 =__ <br /># of Labels <br /> <br />N/C <br /> <br />FEES <br />A 1. Enter total of fees from Sec. t/4 <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br />B. Entor 25% of line A 1 for Plan Review <br /> (Sec. 3), if r~quir*d <br />C. Inveatigation Fee (if required) <br />D. R¢impsction Fe~ ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br />15-34 1.7/94 <br /> <br /> <br />