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FOR CITY VALIDATION Received by: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE - Room 132 Salem, OR 97301 ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 5 1. LOCATION~ _,~F I~_~ATION Directions 24 Hr Inspection Lino: 588-7904 Office: 588-5147 8:00 a.m. - 4:30 p.m. FAX: 588-7948 PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN lB0 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY ElectricalContractor ~/(._~ }Phone2~/_Tt/~--L. '- ' 1..-- 2B. FOR OWNER INSTALLATIONS Property Owner (please prinO Mailing Address I Phone City/State/Zip Owner's Signature: 3. PLANRBVIEW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. PERMIT NO: Date: Issued by: cE- }3q5 4. FIlE SCHIIDULII (Complete and enter total in Al below) Number of Inspections per permit allowed R~idential Per Unit / Servic~ Included: Items Co~t (each) Sum 1000 sq. ft. or less $85.00 4 Each additional 500 sq. ft. or portion thereof $15.00 Limited Energy $20.00 1 Each Manufactured Home or Modular Dwelling Service or Feeder $40.00 ~ 2 B. Services or Feeders (Does not include branch circuits, see section D) Installation, Alteration or Relocation 200 amps or less / $50.00 '~'~ 'ff~'~ 201 amps to 400 amps $60.00 ~ 2 401 amps to 600 amps $100.00 ~ 2 601 amps to 1000 amps $130.00 ~2 Over 1000 amps or volts $300.00 - 2 Reconnect only $40.00 ~ 2 C. Temporary Services/Feeders Installation, Alteration, or Relocation 200 amps or less 201 amps to 400 amps 401 amps to 600 amps Over 600 amps or 1000 volts see "B" above D. Branch Circuits New, Alterations, or E~tension Per Panel a) The fee for branch circuits ~ ourchase of service of feeder fee EaCh branch circuit ~ $35.00 __ 2 $4O.00 __2 $80.00 ~ 2 b) The fee for branch circuits without purchase of service or feeder fee First branch circuit Each additional branch circuit $35.00 $2.~ E. Miscellaneous (Service or Feeder Not Included) Each pump or irrigation circle $40.00 Each sign or outline lighting $40.00 Signal circuit(s) or a limited energy panel, alteration or extension $40.00 F. Each additional ln~p~tion Over the allowable in any of the above, per Inspection $35.00 ~. Minor Installation Labels Pack of 10 labels @ $5.00 each $50.00 (sold only to electrical contractors) H. Othe~ (As required by Budding OIliciaO Aumm Dwelling Electrical Fee Dwelling Permit Label # of Labels ~sq. ~. x $.06 = N/C 5. FEES A 1. Enter total of fees from Sec. #4 A2. Add 5% surcharge (.05 x Al) Subtotal B. Enter 25% of line A1 for Plan Review (Sec. 3), if required C. Investigation Fee (if required) D. Reinspeetion Fee ($25.00) TOTAL AMOUNT DUE Receipt No. MC 15-34 12./94