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IFOR. OFFICE USE ONLY I <br /> Received by: <br /> Date: ' <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> P/ease complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />28~ Church St. NE - Room 132 <br /> Salem. Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> C~=-A-I't.~: ~SS-Vg04 SITE <br /> #: <br /> FAX: 588-7948 <br /> <br />Date; <br /> <br />issued by: <br /> <br />Permit No. <br /> <br />1, LOCATION OFINSWALLATION <br /> <br />PERMTIS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRIi I~ WORK IS NOT S"fAI~I~D ~ 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLy <br /> <br />conmctoes Licks= 1%. ~'~ -L~ C_ <br /> <br />Contractoes Board Reg. No. ~ ~, ~-,~ ~ <br /> <br /> FOR OWNER INSTALI~TIONS <br /> <br />Prol~ny Owner <br /> <br />Mailing Address Phone <br /> <br />City/StatdZip <br /> <br />The installation is being made on p~perty I own which i~ ~ intended for sale, <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <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 program doe~ not suspead tho <br />required submission of tighting 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 />4. FEE SCHEDULE (Complete and enter total in A1 balow) <br /> <br /> Number ef Inapeetlons Ira' pormlt all~wed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> <br /> 1000 sq. iL or les~ $85.00 <br /> Each additional 5~ sq. h. <br /> ~ po~m ~hemof $15.00 <br /> Limited Energy $20.00 <br /> ~ach Mannfd Home or Medular <br /> Dwelling Sexvine or Feeder $40.00 <br /> <br />B. Servt~ or Peeders (Doe4 not inlcude branch circulU, sec section <br /> <br /> lnalallation, Alterations or Relocation <br /> 200 amp~ or less ./ $~0.00 ~' ~2 <br /> 201 aml~ to 400 amps $60.00 2 <br /> 401 amgz to (;00 amp~ $100.00 2 <br /> 601 am~ to t000 aml~ $130.00 2 <br /> Over t000 amps or voks $300.00 2 <br /> Reconnect atiy $40.00 2 <br /> <br />C. Temporary Servlce~JFeedors <br />In~allatioa, Alteration, or Rdocaflon <br />200 amps or kss $35.00 2 <br />201 amps to 400 ampz $40.00 2 <br />401 amps to 600 ampz $80.00 2 <br />Over 600 amps or 1000 volts <br /> <br />D, Branch Circuits <br /> New, Alteration, or Extmsinn Per Panel <br /> <br /> a) The fee for branch 6rcuits w;th <br /> ourchas= c~ sendc~ or fe~der fee <br /> <br /> Each branch ~i~mait /~, ~ ~{ ""'" <br /> sa.00 <br /> <br /> b) The fee fc~bmnch clrcuu without <br /> vurchase of service or feeder fee <br /> <br /> Each additional bramch circuit $2,00 <br /> <br />E. MIseellaneous (Ser-vlee or Feeder Not Included) <br />Each pump or inlgalhm circle $40.00 2 <br />Each sign or outline lighting $40.00 2 <br />Signal ~s) or a ~it~d energy <br />panel, alteration or exteansion $40.00 2 <br /> <br />p. F_ach addRional Impeetion <br />over the allowable in any of the <br />above, per Impeetion $35.00 <br /> <br />G. Minor Installation Labels <br />Pack of 10 labels @ $5,00 each $50.00 <br />(sold onl~ to electrical con~ractors) <br />IL Other <br />(As ~quir*d by 8aitd{ng Official) <br /> <br />5. FEES <br /> Al. Eater total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of lin~ A 1 for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (ff required) <br /> D. Reinspcction Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />Receipt No. <br /> <br /> <br />