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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> Phon~ 588-5147 8.*00 ~n - 4:30pm 24--1]~ LRSPECTION L/tIE: (503) 373-4427 <br /> Code-A-Phone: 588-7904 Permit No. <br /> FAX: 588-7~48 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION ~.~E~VF~ <br />Please complete all Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />JobAddress 8900 HILL CREEK ED <br /> <br />C~ty AUMSVILLE [ CrossS[ <br /> <br />s- dARI0N COU! <br /> <br />Directions <br /> <br />Desc6pfion 120VOLT CKT FOR CONTROL PANEL <br />(2)SIGNAL CKT8 TO UG TANKS <br /> <br />pERMITS ARE NON-TRAI~FERABLE AND NON-KEFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WIll-lIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />70A <br /> <br />FOR OWNER INSTALLKTtONS <br /> <br />Pmpex'ty Owner <br />Mailing Address Phone <br />Ci~flState/Zip <br /> <br />'l'~c installation is being mad~ on pro.ny I own winch is net intended for sale, <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service ff you complete Section <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 11/91 <br /> <br />4. FEE SCHEDULE (Complete ~md enter total/n Al below) <br /> Number of Inspections p~- permit allowed -] <br /> <br />A. <br /> Re~identlnl <br /> Per <br /> Unit <br /> / <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> lO00 *q. f~ or less $85.00 4 <br /> Each addi. fiona1500 sq. ft <br /> or perd~ th.mol $15.00 -- <br /> Limed Energy $20.00 -- 1 <br /> Each Manufd Home or Modular <br /> Dwel[i~ Service c~ Feeder $40.00 2 <br /> <br />B. Se~lces or Feeders (Does not inlcude branch circuits, sec section D) <br /> Installation, AIt~atinns m. Rdocatlon <br /> 200 amps or less $50.00 __ 2 <br /> 201 amps to 400 amps $60.00 -- 2 <br /> 401 aml~ m 6(X3 amps $100.00 -- 2 <br /> 601 ~Lmps m 1000 amps $130.00 2 <br /> Over 1000 amps or volts $300.00 __ 2 <br /> Rexx~nect c~y $40.00 -- 2 <br /> <br />C, Temporary Services/Feeders <br /> <br /> 200 amps or less $35.00 2 <br /> 201 amFs to 400 amps $40.00 2 <br /> 401 amps to 600 amps $80.00 -- 2 <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Circuits <br /> New, Alt~atlon, or Ex'tendon Per Panel <br /> <br /> a) The fcc fe~ branch circuits wi~ <br /> <br /> Each branch circuit $2.00 <br /> <br /> b) The fee for branch circuts withcut <br /> ourcbese of scoriae or feeder fee <br /> <br /> First branch circuit -- 1 $35.00 35 · <br /> Each additional branch circuit $2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> ~ pump or in~gntlon circle $40.00 2 <br /> Each sign or outline lighting -- $40.00 -- 2 <br /> Signal circuit(s) or a limited energy <br /> paud, alteration c~ extrusion -- 1 $40.00 ~ 2 <br /> <br /> F. Each additional Inspection <br /> over the allowable in any of the <br /> above, per Inspection $35.00 <br /> <br /> G. Minor Installation Labels <br /> Pack c~ l0 labels ~ $5.00 each $50.00 <br /> (sold only to electrical contractors) <br /> <br />H. Othe~ <br /> (As required by Building Official) <br /> <br />5. FEES <br /> Al. Enter ttaalof fees from Sec. #4 $ <br /> A2. Add 5% surcharge 605 x A1 ) $ 3.7 5 <br /> Subtotal $ 78.75 <br /> <br /> B, Enter 25% oflineA1 for Plan Review <br /> (Sec. 3), if required $ <br /> C. Investigation Fee (/f required) $ <br /> D. Reinspection Fee ($25.00) $ <br /> TOTAL AMOUNT DUE $ 78.75 <br /> Receipt No. <br /> <br /> <br />