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FOR OFFICE USE ONLY Rece~ved b~: Date: ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 5 1. LOCATION OFINSTALLATION MARION COUNTY BUILDING INSPECTION 220 High Street NE Salem, Oregon 97301 Phon~ 588-5147 8:00 ~a - 4:3~pm Code-A-Phone: 588-7904 FAX: 5ss-7~4s SITE #: Date: Issued by: Permit No. PERMITS ABE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK IS NOT STABTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY Electrical Coturactor pn~eny Owner Uc=se No. No. 2B. FOR OWNER INSTALLATIONS Prope~y Owner Mailing Address Phone City/State/Zip Owner's Signature 3. PLAN REVIEW SECTION We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. This optional plan review program does not suspend the required submission of lighting power calculations, plans, and specifications when required by the Oregon Stmctt~al Specialty Code, Chapter 53. MC 15-34 11/91 4. FEE SCHEDULE (Complete ~d enter total in A1 be~ow) A. Residential Pex Unit Service Included: 1000 sq. ft, or lezs Each additional 500 sq. ft or pmdon t,t~mof $85.00 4 $15.00 l~united Energy $20.00 Each Manufd Home or Modular Dwel~ag Service or Feeder $40.00 B. Servl~ or Feeders (Does not ildcude branch circuits, see section D) Installation, Alterations or Rdo~atinn 200 am~ or less 201 amps to 4~0 amps 401 amps to 6~0 amps ~01 amps to 1000 amps Over 1000 amps or volts Reconnect enly C. Temporary Services/Feeders Installation, Alteration, or Rein~ation 200 amps or less 201 amps to 400 amps 401 amps to 600 amps Over 600 ~ps or 1000 volts D. Branch Circuits New, Alteration, or Extension Per Panel a) The fe~ for branch cire~ts wEh Each branch ci~eint ~ b) The fee for branch circuts without tmrchase of sev,,iee or feeder fee FL~t brmach circuit Each additional branch circuit E. Miscellaneous (Service or Feeder Not Included) Each pump or ixrigati~m cLrele Each sign or outIine lighting Signal circuit(s) or a limited energy panel, alteration or ey. tensien E Each additional Inspection over the allowable in any of tha above, per Inspection G. Minor Insthllation Lahels Pack of 10 label~ @ $5.00 each (sold only to eleetrical contractors) H. Other (As required by Building Official) I $ o.oo $60.00 2 $100,00 2 $130.00 2 $300,00 2 $40.00 2 $35.00 -- 2 $40.00 -- 2 $80.00 -- 2 $2.00 $35.00 $2.00 $40.00 --2 $40.00 2 $40.00 $35.00 $~o.oo 5. FEES Al. Enter total of fees from Sec. #4 A2. Add 5% surcharge (.05 x Al) Subtotal B. Enter 25% of line A 1 for Flan Review (Sec. 3), if required C. Investigation Fee (ff required) D. R(mspection Fee ($25.00) TOTAL AMOWNT DUE Receipt No. $ $ $