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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVF. LOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line:. 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directions <br /> <br /> I <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 />Contraclor's Board Reg. No. q ~'~33 Job No. <br />Si~n at~r-e-o~ S u perv isin~ Elec tricim~ <br /> - sor's Lice.s No. 3t"-5'3 <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (please print) <br />Mailing Address Phone <br /> <br />Cily/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW 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. File SCHEDULE (Complete and enter total in Al below) <br /> Number oflnspections pet permit allowed -~ <br /> Rnsidential <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 oortion Ihereof $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. 8erviee~ ot Feeders (Does not include branch circuits, see section D) <br /> 2001nstallati°n' Alteration °r Rel°eationIamps 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 __ 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 />N~w, Altorations, or Extension Per Panel <br />a) 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 /> p0rehase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.00 __ <br />$ 2.00 __ <br /> <br />E. Miscellaneous (,¶h~vieoor Feeder Not Included) <br />Each pump or irrigation circle $40.00 __ 2 <br />Each sign or outline lighting $40.00 __ 2 <br />Signal circuit(s) or n limited energy <br />panel, nltetntion or extension $40.00 __ 2 <br />F. Each additional Inspection <br />Over the allowable in nny of the <br />above, per Inspection $35.00 __ <br />O. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 __ <br />(sold only to electrical contractors) <br />H. Other <br />(As required by Building Oll~cial) <br /> Aurora Dwelling Electrical Fee ~sc/. E. x $.06 = __ <br /> Dwelling Permit Label # of Labels N/C <br /> <br />FEES <br />Al. Enter total of fees from See. #4 $ <br />A2. Add 5% surcharge (.05 x Al) $ <br /> Subtotal $.~ <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if r~quimd <br /> C. Investigation Fee (if required) $.__ <br /> D. Reinspection Fee ($25.00) <br /> <br /> Receipt No. <br /> <br />MC 15-3412/94 <br /> <br /> <br />