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., MARION COUNTY BUILDIN6 INSPECTION <br />· COMMUNITY DEVEL??MENT CENTER <br /> I 285 Church StNE Room 132 p~l~l¥~al~. <br />FOR CITY VALIDATION Salem, OR 97301 '~'- ' <br />R~eived by:, <br />Date: ~ Hr Inaction L~o: 58&7~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directions <br /> <br />'5¢6 IAi haemex <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COiN-TRACTOR INSTALLATION ONLY <br /> <br />MailingAddr. s 5q/z,90 Na. rkeL <br />~°per~Y °wrier LV n ~?F//6 <br /> roii Pb°ne,~ I--O <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Property Owner (please priat) <br />Mailing Address ] Phone <br />City/State/Zip <br />Owner's Signature: <br /> <br />3. PLAN REVIBW SBCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-34 12/94 <br /> <br />4. FEE SCHEDULE (Complete and enter {oral in Al below) <br /> Nmnber of Inspections per permit allowed -~ <br /> Residential <br /> Per <br /> Unit <br /> / <br />Service Included: Items Cost (each) Sum <br />1000 sq. ft. or less $85.00 4 <br />Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 __ 2 <br /> <br />B. Services or Feeders (Does not include branch cimuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less $50.00 __ 2 <br /> 201 amps to 400 amps $60.00 ~ 2 <br /> 401 amps to 600 amps $100.00 __2 <br /> 601 amps to 1000 amps $130.00 __ 2 <br /> Over 1000 amps or volts $300.00 __ 2 <br /> Reconnect only $40.00 __ 2 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alteration, or Relocation <br />200 amps or less $35,00 __ <br /> 201 amps to 400 amps $40.00 __ <br />40 1 maps to 600 amps $80.00 __ <br />Over 600 amps or 1000 volts <br />see "B" above <br />D. Branch Circuits <br />New, Alterations, or Extension Per Panel <br />a) The fee for branch circuits with <br />purchase of service of feeder fee <br />Each branch circuit $ 2.00 <br /> <br />2 <br />2 <br />2 <br /> <br />b) The fee for branch circuits without <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$ 2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br />Each pump or irrigation circle $40.00 <br />Each sign or outline lighting $40.00 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 <br />F. Each additional in~eetion <br />Over the allowable in any of the <br />above, per Inspection $35.00 <br />;3. Minor Installation Labels <br />Pack of I0 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />H. Other <br />(As required by Building O~cial) <br />Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label # of Labels <br /> <br />sc/. ~q. x$.06 = __ <br /> <br />N/C <br /> <br />5. FEES Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if requircd <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOUNTDUE <br /> <br />Receipt No. <br /> <br /> <br />