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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />24 Hr Inspection Line: 588-7904 <br />Office: 588-5147 8:00 n.m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br />MARION COUNTY BUILDING INSPECTI~ <br /> 285 Church St NE Room 132 I~l[[~lT <br /> Salem, OR 97301 '~"~-' J'A '2 9 1998 <br /> Date: ii,~ A n,n .......... <br /> mru nunl bUUN I ¥ <br /> issu~. NG I~SPEC/IOI~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease comploto ali Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directions <br /> <br />PERM1TS 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. COHTRACTOR INSTALLATION ONLY <br />Electrical Contractor ~ ~ 9&C~,' Phone'l~ -'~ 5~ ~4 <br />MailingAddrcss ~ ~]0~ 473 7~.J, f~f~- q~ / <br /> <br />Supe~isor's License No. ~OC~ Phone <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Properly Owner (p/ease print) <br /> Mailing Address I Phone <br /> City/State/Zip <br /> Owner's Signature: <br /> <br />3. PLANRBVIBW 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 />4. FEE SCHEDULB (Complete and enter wtai in A1 below) <br /> Number of Inspections per permit allowed -~ <br />A. <br /> Re~identini <br /> Per <br /> Unit <br /> Service Included: ltema 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 />B. Services or Feeders (Does not include branch circuits, 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 1540.00 ~ 2 <br /> <br />C. Temporary Surviees/Feeders <br />Installation, Altoration, 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 with <br />p~f~chase 9f service of feeder fee <br />Each branch circuit $ 2.00 <br /> <br />b) The fee for branch cimuits without <br /> purchase of service or £o¢der fee <br />First branch circuit <br />Each addhional branch circuit <br /> <br />$35.~ <br />$2.~ <br /> <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension <br />F. Each additional In~eetion <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 Oil?rial) <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />Miscellaneous (Service or Feeder Not Included) <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />~.sq. ff. x$.06 = ~ <br /># of Labels <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 required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOUNTDUE <br /> <br />Receipt No. <br /> <br />MC 15-34 12/94 <br /> <br /> <br />