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MARION <br /> COUNTY <br /> BUILDING <br /> INSPECTION <br />FOR OFFICE USE ONLY [ <br />ReCeived by:. ' [ 220 High S~-eet NE <br />Date: [ Salem, Oregon 97301 <br /> <br /> Phoae 588-5147 8.00 am - 4:30pm <br /> ~, ~-A-Ph~: 558-7904 Permit No <br /> ELECTRICAL PERMITAPPLICATION~ ~ ~ L~ ~ ~/~ ~-~ Date:_ ____ <br /> Please complete all Sections, 1 througT~ ~ ler'- - ~'J · .. <br /> ! ,~:U 2 2 F)~7~1~ msuea oy: __ __ <br /> <br /> L LOCATION OF INSTALLAT[ON MAR[ON C0U ]'~k FEE$CHEDULE(C~npletemdemertotalmAlbele,) <br /> <br />PERMITS ARE NON-1]~tN~F[H~J~LE AND NON-REFUNDAB LE AND <br />EXPOS 1~ WORK IS NOT - ~0 DA'z'~ Ot~IS~UA.N'CE <br />OR 1~ WORX IS SUSPE~I-DED FOR 180 DAYS. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owrmr <br />M~,'t~ Addr~s Phone <br /> <br />The thstal~t~n is being made on property I own which is noc intended for sale, <br /> <br />Owners SlSa~mm <br /> <br />3. Pf~N REVIEW S,~TrlON <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review pregram does not suspend the <br />required submission of fighting power calculations, plans, <br />and specifications when required by the Oregon SIructural <br />Specialty Code, ChalXer 53. <br /> <br />MC15-34 11/91 <br /> <br />:TI 0 N Numbo- ~ laspeclleas per permit .llowed <br /> <br /> ~ R~enfld ~ Unit <br /> S~l~ In~d~: h~s Cmt (~) <br /> 1~ sq, ~ ~less ~.00 4 <br /> <br /> ~ ~m ~f $15.00 <br /> ~ ~ $~.001 <br /> ~ ~d H~ ~ M~ <br /> Dw~ S~ ~F~ $~,00 <br /> <br /> B. ~ ~ Fe~e~ ~ ~ ~ ~ ~, s~ ~ D) <br /> <br /> 200 amps or less ~0005~0100 --2 <br /> 201 ~mps to 400 amps 2 <br /> 401 amps to 600 amps $100.00 2 <br /> · )l arnp~m lO00amps $130.00 -- 2 <br /> Over 1000 amps o~vo~ $300.00 2 <br /> Reco~mect only $40.00 2 <br /> <br /> C. Teaqmra~y Survlees/~eede~s <br /> Installation, llteratina, or Rdocafloa <br /> 200 amps or less $35.00 2 <br /> 201 amps to 400 amps <br /> 401 amps to C~0 amp~ ~)~:0000 <br /> Over 600 amps or 1000 volts <br /> <br />D. Br~n~h Circuits <br /> New, Alteration, or Exte~slo~ Per Panel <br /> <br /> a) '[he fee for blanch drcuits wlth <br /> ourchase Of Seorice or feeder gee <br /> <br /> Each branch c'i~uit $2.00 <br /> <br /> b) The fee far branch clrcuts without <br /> ourcha~e of sendce or feeder t~.~ <br /> <br /> Each additional br~h circuit $2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump ~ izfigafion circle $40.00 2 <br /> Each sign or oodine .l~h~.' g -- $40.00 2 <br /> Signal circuit(s) or ~ ~imited eoersy <br /> panel, al~enuion e~ extension $40.00 2 <br /> <br />F, F~¢h add#lorml Inspeotio~ <br />over the allowable in any of the <br />above, per Inspec~co $35.00 <br /> <br />O. Minor I~stallaflon L~bds <br />Pack Of 10 labels @ $5.00 ~ch $50.00 <br />(sold only to electrica~ con~ractors) <br />lt. Other <br />(~ requ/red b~ Building Offic/a0 <br /> <br />5. FEES <br /> Al. Emer ~ of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of lineAl for Plan Rev/ew <br /> (Sec. 3). ff n~quired <br /> C. Investigation Fee (if mqui~.d) <br /> D. Reinspecdon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Recei~ No. <br /> <br /> <br />