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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO: <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 WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor Phone <br />Mailing Address <br />Property Owner Phone <br />Contractor's License No. <br />Contractor's Board Reg. No. .lob No. <br />Signature of Supervising Electrician <br />Supervisor's License No. Phone <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Property Owner (please print) ~ ~__~ <br />Mailing Address PO <br /> <br />City/State/Zip <br />Owner's Signature: ~/ff_~_ j~ ~ <br /> <br />3. PLANRRVIEW 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 />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHBDULE (Complete and enter total in Al below) <br /> Number of Inspections per permit allowed --~ <br /> R~identiai <br /> P~r <br /> Unit <br /> ! <br />,%rvie~ Included: Items Coat (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 />Service~ or Fe~ders (Does not include branch circuits, see section D) <br />Installation, Alteration or Roiooation <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 Serviees/Feoders <br />Installation, Alteration, or Relocation <br />200 amps or less $35.00 -- 2 <br />201 amps to 400 amps $40.00 ~ 2 <br />401 amps to 600 amps $80.00 ~2 <br />Over 600 amps or 1000 volts <br />see "B" above <br />D. Branch Circuits <br />New, Alterations, or Extension Per Panel <br />n) The fee for branch circuits ~ <br />purchase of service of feeder fee <br />Each branch circuit $ 2.00 ~ <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 />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuit(s) or n limited energy <br /> panel, alteration or extension <br />F. Each additional Inspection <br /> Over the allowable in any of the <br /> above, per Inspection <br />O. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each <br /> (sold only to electrical contractors) <br />H. Other <br /> (As required by Building Official) <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />$35.00 __ <br />$ 2.00 __ <br /> <br />$40.00 ~2 <br />$40.00 ~ 2 <br /> <br />$35.00 ~ <br /> <br /> sq. fl. x $.068 = -- <br /># of Labels 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 A 1 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 />