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FOR CITY VAIXDATION <br />Received by: <br />Date: <br /> <br />/~/JELECTRICAL PERMIT APPLICATION [ <br /> Ple~. e complete all ~eCtions, I through 5 I <br /> <br /> ' <br /> <br />PERMIT NO: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 ~ <br /> :a~ Date: <br /> 24 hr. Inspection Line 373-4427 ~ <br /> Office: Phone 588-5147 8:00am - 4:30pm ~ ~ <br /> FAX: 588-7948 ~ Issued by: <br /> <br /> =alt <br /> <br /> 4.~E 3CHE~OLR (Complete and enter total in Al below) <br /> ,~]X./ ~ Nmnber of hmpeotionn per permit allowed -=---/ <br /> A. Residential Per Unit J <br /> 8erviee Included: Itema C.o~t (eech) Sum I <br /> 1000 sq. t't. or leas $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 $40.00 .. . 2 <br /> <br />PERMITS ARE NON-TRANSI~_~.ABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br />Mailing Address <br /> <br />JPhone <br /> <br />(3onlractor's License No. <br /> <br />Contractor's Board Reg. No. <br /> <br />Signature of Supe~ising Electrician <br /> <br />No. <br /> <br />Supetvisor's Liccme No. I Phone <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pmpe~ Owner (p~so ptiv~) <br /> <br />CitylSta~rz~ <br /> <br />B. Services or Feeders (Does not include branch circuits, see section D) <br /> Installation, Alteration or Rdeeation <br /> 200 amps or lesa $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. Temperary 8erviceJ/F~zlera <br /> Installation, Alteration, or Roloeation <br />~' 200 amps or leaa ~ ~- ~ <br /> <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 volts <br /> aec "B' above <br />D. Bzaneh Circuits <br /> Nenv, Alterations, or Exton~ion Per Panel <br /> ay~ fee for branch circuits with <br /> purcheae of service of feeder fee <br /> Each branch circuit <br /> <br />Owner's Signature: <br /> <br />$35.00 ~ 2 <br />$80.00 ~ 2 <br /> <br />$ 2.00 <br /> <br />b) Thc fee for branch circuits without <br /> .ma'chase of service or feeder fee <br />First brnnch circuit <br />Each additional brmch circuit <br /> <br />3. PLANRBVIEW 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 />$35.00 <br />$2.00 <br /> <br />E. Miscellaneous (~ervie~ er Feeder Not inoluded) , <br />Each pump or irrigation circle M0.00 ~ 2 <br /> Each sign or outline lighting $40.00 2 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 ~ 2 <br />F. Each additional lmpection <br />Over the allowable in nny of the <br /> above, per Impection ~ <br /> <br /> Mimx Installation labels ' ~-~ $35.00 <br /> <br /> Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />H. Other <br />(As required by Building Ottfcial) <br />Aurora Dwelling Electrical Fee sq. fi. x $.068 = ~ <br /> Dwelling Permit Label # of Labels N/C <br /> <br />5. FEES <br /> <br />Al. Enter total of feea fwm See.//4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />~bto~al <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />