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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dkeetions <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. COHTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address "') ~) 5(<~ L C.,.¢"~,-~ <br />~p~ ar tcYto~, aw ~.i en se No.. Phone -, <br /> <br />Su rvi r'sLicense.o. Cv-'q <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please pri~) <br /> <br />Mailing <br /> Address [ Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLANRBVIRW SBCTION <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 />MC 15-34 1/96 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEB SCHBDULB (Complete and enter total in Al below) <br /> Nmnber of Inspections per permit allowed ----] <br /> R~idantial <br /> Per <br /> Unit <br /> / <br />Service Include~i: Items Cost (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. Services or Feeders (Does not include branch circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less } $50.00 ~'q, o~ <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 <br />201 amps to 400 amps $40.00 <br />40 1 amps to 600 amps $80.00 <br />Over 600 amps or 1000 volts <br />see "B" above <br />D. Branch Circuits <br />Hew, Alterations, or Exlension Per Panel <br />a) The fee for branch circuits ~ <br />purchase oj_s~/ice of feeder fee <br /> Each branch circuit ~ $ 2.00 <br /> <br />b) The fee for branch circuits without <br /> gurchase~zf_s_erv~:x~_~ feeder fee <br />First branch circuit <br />Each additional brm~ch circuit <br /> <br />$35.00 ~ <br />$ 2.00 __ <br /> <br />E. Miscellaneous (Service or Feeder Not 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 any of the <br />above, per Inspection $35.00 <br />0. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />H. Oth~r <br />(As reqnired by Building Otl~cial) <br />Aurora Dwelling Electrical Fee <br />Dwelling Permit Label <br /> <br /> sq. fl. x $. 068 = __ <br /># of Labels N/C <br /> <br />jo <br /> <br /> 2 <br /> 2 <br /> <br /> 2 <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 /> <br />