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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.' 588-7904 <br />Office: 588-514/ 8:00 a,m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />D~ctio~ <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 />2B. FOR OWI~R INSTALLATIONS <br />Property Owner (please print) <br />Mailing Address Phone <br />City/State/Zip <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 />Date: <br /> <br />Issued by: <br /> <br />4, I~E SCHEDULB (Complete and enter total in Al below) <br /> Number of Inspections per permit allowed <br /> R~idential <br /> Unit <br /> / <br /> 8ervi~ Included: ltema Co~t (each) Sum <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. S~rvie~ or Frontiers (Does not include branch circui~ see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less $50.00 <br /> 201 amps to 400 amps -"T- $60.00 <br /> 401 amps to 600 amps $100.00 __ 2 <br /> 601 amps to 1000 amps $130.00 __ 2 <br /> Over 1000 amps or volta $300.00 - 2 <br /> Reconnect only $40.00 __ 2 <br /> <br />C. Tmnporary ,%rviemdFeeders <br />Installation, Alteration, 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 volta <br />see "B" above <br />D. Branch Circuits <br />Hew, Alterations, 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 brnnch circuits without <br /> purchase 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 (,~Jerviceor Feeder Not Included) <br />Each pump or irrigation circle $40.00 __ 2 <br />Each sign or outline lighting $40.00 __ 2 <br />Signnl circuit(s) or n limited energy <br />panel, alteration or extension $40.00 __ 2 <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, per Inspection $35.00 __ <br />Cl. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />II. Other <br />(As required by Building Ott~ciaO <br />Auwra Dwelling Electrical Fee <br /> Dwelling Permit Label N/C <br /> <br />__,sq. fl. x$.06 = __ <br /># of Labels <br /> <br />FEE 8 <br />A 1. Enter total of fees from Sec.//4 <br />A2. Add 5% surcharge (.05 x Al) <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 AMOUNT DUE <br /> Receipt No. <br /> <br />MC 15-34 12/94 <br /> <br /> <br />