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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 <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 />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directions <br /> <br />Description <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. CON-TRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor I Phone <br /> <br />Mailing Address <br />Propetay Owner { Phone <br /> <br />Job No. <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Reg. No. <br /> <br />Signature of Supervising Electrician <br /> <br />Supervisor's License No. } Phone <br /> <br />3. PLANREVIEW 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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> Nmnber of Inspections per permit allowed <br />A. Residential Per Unit <br /> Service Included: Items Cost (each) Sum <br /> 1000 sq. fl. or less $85.00 4 <br />Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br />Limited Energy / $20.00 ..~ <br />Each Dwelling ~ Feeder / $40.00 <br /> Manufactured H/nne"/~odular <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 <br /> Over 10ft) 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 <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 />N~w, Alterations, or Extension Per Panel <br />a) The fee for branch circuits with <br />purchase of service of feeder fee <br />Each branch circuit $ 2.00 <br /> <br />b) The fee for branch circuits without <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch eircnit <br /> <br />$35.00 <br />$ 2.00 <br /> <br />E. Miscellaneous (Service or Feeder No~ Included) <br />Each pump or irrigation circle $40.00 <br />Each sign or outline lighting $40,00 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 <br />F. Each additional Inspection <br />Over the allowable in nny of the <br />above, per Inspection $35.00 <br />{3. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />H. Other <br />(As required by Building Oll~ciai) <br />Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />__.~q. #. x$.06 = ~ <br /># of Labels <br /> <br />IqlC <br /> <br />5. FEES <br />Al. 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 />