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FOR CITY USE ONLY Received By: .Date: Zoning By: .City: Receipt ~. Amount: $, ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 5 1. LOCATION OF INSTALLATION Cross StrecffDirections: ProjectDeacription: q~O~tt' ~.V /~4c~_ [PEP~I1TS AND E~IRE IF WO~ ~E NON.~NSFE~ IS NOT ST~T~ ~THIN 180 DAYS OF ISSU~CE OR IF WORK IS SUSP~DED FOR 180 DA~. 2B. ~R O~ ~STAL~~ M~ling A~s: st~m~ i~ ~oM or ~emd for sale b~o~ or ~n completio~ ~ I hi~ ~on~w~, I will hi~ only s~on~actors ~gi$temd with t~ C~t~ Come,ors B~ Ill c~nge my mi~ ~ ~ Con~to~ B~ I will ~dlately ~t~ Ma~ Co~ of ~ ~ of t~ ~. PLAN REVIEW SECTION review ~vice if you complete Section 51t and submit ~o (2) set* of plans and specifi¢~-tions with this application. MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 4. FEE SCHEDULE (complete and enter total in Al) Nural~r of Iasp~ctiotm p~r l~tit allow*/ A. Residential Per Unit Service Included: Itenm Cost (each) Sum 1000~l. fl. orless -- x $110.80=$__4 Each additional 500 sq. ft. or portion tlgrcof -- x $20.00 = $ IAmi~l Ea~ x $30.00--$ I Each Manufactured Home o~ Modular DwelIh~g Service or Feeder -- x $52.00 = $ -- 2 B. Servkes or F~ders (D~s not i~glade brm~h Circuits, see s~ion D) Im~tellaflo~, Alteration or Reloeotion 200 ~aps or less I ~' x $65,00 = $ -- 2 201 amps to 400 amps ~t x $80.00--$__2 401 amps to 600 amps -- x $130.00=$__2 601 amps to 1000 amps -- x $170.00 = $__ 2 Over 1000 amps or volts -- x $590.00 = $ 2 R~c~ Only 200 amps or less -- x $45.00 = $ -- 2 201amps to 400 amps -- x $55.00=$__2 401 amps lo 600 mk~ x $1!.0.00=,$__2 Over 600 amps or 1000 volts see "B' above a) ~ f~e for br~lch circuits with Each branch circuit !~ x $3.00 -- $ -- First branch circuit -- x $50.00 =~ $ -- IF~eh additional branch ciguit -- ~ $3.00 =, $ -- g. Mlec~lla~ec~ (Service or Feeder Not lncladed) Each pump or irti/ation circle Each Sign or Outline Lighting x $$5.00 = $ -- 2 Si~l Ciwuiffs) or a Limited F. F~ch eddlflo~al over the allowable in ~ny of the above, per ~peedon -- x $50.00 = $__ Om/TwoF~lyVwmlngF~e:Sq.F~e~ __ x $ .0~=$__ Al. Enter total of feas f~om Sec. e4 A2. Add State Sumhat~ 605% x Al) SUBTOTAL B. Enter 30% of line Al for Plan Review C. Investigation Fee (if required) D. Reimpection Fee ($50.00) E, Additional Plan Review ($62.50;hr, miuimum one-half hour) E Inspection for which no fee is specifically indicated, ($62.50/hr. minimum one hour) G. Inspection Outside Normal Business Hours, ($62.50/hr, minimum two hours) H. Industrial Plant ($62.50/hr) TOTAL AMOUNT DUE $ $__ $ $ MC 15-34 Rev 9/98