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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 24 hr. Inspection Line 373-4427 Office: Phone 588-5147 8:00am - 4:30pm FAX: 588~7948 IELECTRICAL PERMIT APPLICATION Please complete all .~ections, I through 1. LOCATION OF INSTAL~~ON ~fipfi~ PERMITS ARE NON-TRANSFERABLE AND EX~IRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. COHTRACTOR INSTALLATION ONLY Electrical Contractor I Phone Mailing Address Property Owner I Phone Contractor's License No. Contractor's Board Reg. No. Job No. Signature of Supervising Electrician Supervisor's License No. I Phone 2B. FOR OWNER INSTALLATIONS 3. PLANREVIBW 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. MC 15-34 1/96 PERMIT NO' Date: Issued by: 4. FEll SCHBDULll (Complete and enter total in Al below) Number of Inspections per permit allowed A. Residential Per Unit -~ Service Included: Items Cost (each) Sum 1000 sq. fl. 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 Services or Feeders (Does not include branch circuits, see section D) Installation, Alteration or Relocation '~200 amps or less /' $50.00 .~--2 201 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 mnps or less $35.00 __ 201 amps to 400 amps $40.00 __ 401 ainps to 600 amps $80.00 __ Over 600 amps or 1000 volt~ see "B" above D. Branch Circuits New, Alterations, or Extension Per Panel a) The fee for branch circuita ~ purchase_of~e~jce of feeder fee Each branch circuit $ 2.00 __ b) The fee for branch circuits without purchase of~e~ykce~or feeder fee First branch circuit Each additional branch circuit $35.00 __ $ 2.00 ~ 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 Inspection Over the allowable in any of the above, per Inspection $35.00 O. Minor Installation Labels Pack of I0 labels @ $5.00 each $50.00 (sold only to electrical contractors) H. Other (As required by Building Otl~ciaO Aurora Dwelling Electrical Fee Dwelling Permit Label ~sq. fi. x $. 068 = ~ # of Labels N/C 5. FEES Al. Enter total of fees from Sec. #4 $__ -~A2. Add 5% surcharge (.05 x Al) $.~ Subtotal $.~ B. Enter 25% of line A 1 for Plan Review (Sec. 3), if required C. Investigation Fee (if required) D. Reinspection Fee ($25.00) TOTAL AMOUNT DUE Receipt No.