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MARION COUNTY BUILDING INSPECTION <br /> <br /> 285 Chtu'ch St. NE - Ro~m 132 <br /> Salem, O~egoa 97301 <br /> <br /> Phone 588-5147 8.'00 am - 4:30pm <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> DEC 1 6 <br /> <br />BUILDIN~ INS <br /> <br />PER_MFrs ARE NON.TRANSFERABLE AND NON*REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPI~)ED FOR 180 DAYS. <br /> <br />co~,~,~oe, u~,e.o. ~.lqB CaF. <br />C~ntractor's Board Reg, No~ ~ <br /> <br />2B. FOR O~ INhALaTIONS <br /> <br />Pro~ ~r <br />Mailing Address [Pl~e <br /> <br />City/Sta~e/Zip <br /> <br />The imtalh6o~ is being made on property I own which is n~ im~nded fo~ sale. <br /> <br />~cf= Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br /> <br />SITE It: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> panel, alterauon or cxt~sion <br /> <br />F. Each additional [n~pectl~ <br /> ova' d~ alk~ab~in airy ~d ~ <br /> <br />O. Minor laslaBatlon Labeb <br /> Pack ~ 10 lab~h @ $5.00 each <br /> (sold only to electrical conlractor$) <br /> <br />H. Other <br /> ( As required by Budding Official) <br /> <br />5, FEES <br /> A I. Enter total of fees from Se.c. #4 <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> ResldenUal <br /> Per <br /> Unn <br /> 1 <br /> Sel~rke Inclmled: hams Co~t (each) <br /> <br />1000 ~:1, ~ or less $85.00 4 <br />Each addiMonal 500 sq. fi. <br />Lim~ni~ the~of $15.00 <br />Each M--~ne or M~dulu~,~,,n $2000 -- 1 <br /> <br />B. Sel~ or Feede~ (Does not i~lcude branch c~ rcuiu, see se. COon D) <br /> Installnlton, Aleetaaons ea' Rdocatlon <br /> <br /> 2~1 amps to 400 amps $60.00 <br /> 401 amp~ to 600 amps $100.00 <br /> 601 amps to I~00 ~ps $130.00 <br /> Over WOO amps or volu $300.00 <br /> R~om~ct ad¥ $40.00 <br /> <br />C. Ttmporary S~rvlce~/Feeders <br />In~allaUo~ AlteraUon, or RelocaUon <br />200 amps or l~s $35.00 2 <br />201 ~nps ~o 400 amps $40.00 2 <br />401 amps to 600 amps $80.00 <br />Over 600 m~ps or 1000 volu <br /> <br />D. Braach CIrcul~ <br /> New, AltweUo,n, or Extension Per Panel <br /> <br /> ~) Th~ fac fo~ branch <br /> mm:hast ~ service ~ feeder fcc <br /> <br /> Each branch circuit $2.00 <br /> b) The fac for b~anch custos wi~o~t <br /> <br /> ~ ~ch ~rcuh $~.00 <br /> Each add~fio~al branch circuit $2.00 <br /> <br />E. Ml~:dlane~s(S~'viceor Feeder Not Included) <br />~ [~e~- i,~igafl~e, c/~cle $~0.00 2 <br />Each £~n ot outline llghdn8 $4000 <br />Signal c/rcuh(s) o~ a hmi~d energy ~ SAO00 '~" <br /> <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 8/94 <br /> <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of lineAl for Plan Re'aew <br /> (Se~. 3), if r~quu~d <br />C. lnves'tigaUon Fee (d ~xluired) <br />D. Reinspecti~m Fee ($25.OO) <br /> <br /> TOTAL A MOD~'NT DUE <br /> <br />ReceT~ No <br /> <br />$ ,40,00 <br /> <br />oat r <br />~J~SCHEDL'LE (Compile ~d ~nter ~ocal m A I bdow) <br /> <br /> <br />