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Received by: I <br />Date: I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED W/THIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> ,// ,// <br /> <br />Signature of Supervising Electrician <br /> <br />Supervlsor's License No. ZT./~____~IO~S~/ <br />2B. FOR OWNER INST <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHHDUL~ (Complete and enter total in Al below) <br /> Number of Inspections per permit allowed .-~ <br /> Residential <br /> Per <br /> Unit <br /> ! <br />Service Included: Items Co~t (each) Sum I <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 />Services or Feeders (Does not include branch cimuit~, 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 10OO amps or volts $300.00 ~ 2 <br />Reconnect only $40.00 ~ 2 <br /> <br />C. Temporary SeFviceMFeedera <br />Installation, Altm'ation, or Relocation <br />200 amps or less $35.00 <br />201 amps to 400 amps $40.00 <br />401 amps 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 ~ <br />13~rchase of service of feeder f¢~ <br />Each branch circuit $ 2,00 <br /> <br />b) The fee for branch circuits ~_yithout <br /> purchase of service or feeder f¢~ <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.OO <br />$ 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 Inspection <br /> <br /> Over the allowable in any of the <br />Property Owner (p/ease rmO' U~.~ ~--~-- j above, per Impection <br /> P ~ [ O. Minor Installation Labels <br /> ~ -- / _ I .-..-~ , ~.-~/ f Pack of 10 labels @ $5.00 each <br />Mailing Address~7/q .~ t~'t'¢~ 'Y~ /~l Pho~Phon~ ~..$~ t~-6,=.~'-T I (sold on/,y to electrical contractors) <br /> ,--. / / I H. Other <br />City/State/Zip ~(_~ld~/~r v')_~//~ ~.~ 3 ~Z~ / I CAsrequireat,yBuilaingOt~ciai) <br /> ,.... - .. ~..=-~ v .__ ~-- r ~ [ I Aurora Dwelling Electrical Fee <br /> , Dwelling Penmt Label <br /> <br /> _~ ./Z-'"~ ./ _ / I Al. Enter total of fees from Sec.//4 <br /> ~ ~ ~ A2. Add 5% surcharge (.05 x Al) <br /> <br />$35.00 <br />$50.OO <br /> <br /> sq. fi. x $.068 <br /># of Labels <br /> <br />Subtotal $.~ <br /> <br />N/C <br /> <br />3. PLANILEVIEW SECTION <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 />B. Enter25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />