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. 4 MARION COUNTY BUILDING INSPECTION <br /> <br /> 285 Church St NE - Room 132 PERMIT NO: <br /> FOR CITY VALIDATION Salem, OR 97301 <br /> Received by: <br /> Date: <br /> Date: 24 Hr Inspection Line: 588-7904 <br /> Ofgi~ 581~-5147 8:00 a.m. - 4:30 p.m. . .. <br /> <br />tELECTRICAL PERMITAPPLICATIONU~ |' ' I U) ' <br /> Please complete ali sections, I through 5J~p~ I ~] 4.j91)~i SC='i~D~E (Complete and e.ter total in A] helow) <br /> -~ ! Nmnber of Inspections per permit allowed '-'-1 <br /> A. Rezidential Per Unit <br /> LOCAt[O i ov INStALL,t, ON .,.. A lOb/dOU_l ,eoIne,nd : Item cost (each, Sum/ <br /> aglLun n~C,, I ~ ~ ~L~.~r.t..or less $85.O0 4 <br /> IobAddress 1~?73 ~Bq-~ I~ AJ~ -I"'Yqt~i~tld~nalS0°sq.n. <br /> or portion thereof $15.00 <br /> City /~Lt~OK~q. Cross st. /k//.~q Limited Energy $20.00 1 <br /> -- Each Manufactured nome or Modular <br /> .Di~ti°~ 77t~,~,~: _a4..~' ~- 77Y'-~? __ _ Dwelling Service or Feeder $40.00 <br /> <br /> B. Services or F~ters (Does not include branch circuits, see section D) <br /> ~[. $11~ t~ ~ff/'l'LEIg i~P ! ~ t~_~ .~' ~be~__,~,~,~'~ Instailation, Alterationor Relocation <br /> Description ~llLtI~& ~oo~ AJlC-ta) J-/n~""/"b(~ 200ampsorless $50.00 <br /> ......... 201 amps to 400 amps $60.00 ~ 2 <br /> I 401 amps to 600 amps $100.00 ~2 <br /> i 601 amps to 1000 amps $130.00 ~2 <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT Over 1000 amps or volts $300.00 ~ 2 <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR 1F Reconnect only $40.00 __ 2 <br /> WORK 1S SUSPENDED FOR 180 DAYS. C. Temporary Servi~a/Fen~dera <br /> lnstallatlon, Alteration, or Relocation <br /> 2A. COHTRACTOR INSTALLATION ONLY 200 amps or less $35.00 ~ 2 <br /> 201 amps to 400 amps $40.00 __ 2 <br /> J 401 amps to 600 amps $80.00 2 <br /> ElectricalContractor ~"t~ t~'LKL/"ttl(~ Itl,Jr... Phone ~'7~ ~[~,,~3- Over 600 amps or l000 volts <br /> see 'B" above <br /> MailingAddress 1~'~, ~a~' ~? Poa~,4t_O.. 01~. ~'~0 D. BranehCireults <br /> Now, Alterations, or Extonaion Per Panel <br /> Property Owner l-o/l-~M'~O Gt'llF_vl. tg'lgl Phone ~ 7~ ' Z~5'0 a) The fee for branch circuits ~ <br /> up~hase of service of feeder fee~ <br /> Each branch circuit $ 2.00 <br /> Contractor Licensee No. ~.. ~ -,~/O ?~L __ ~ -- / b) The fee for branch circuits witho!l! <br /> <br /> First branch circuit - [ $35.00 <br /> S ignat ute of Supervis lng El e c t ri ci~tl~ ~~~~~/~'~'~ ~t~ Each additional b ranch ci re uit $2.00 <br /> Supervisor's LicenseNo..7-7~~'//'t"~,~ ~j('.fl %e~ '~./~"j" E. Mi~cellaneoua (Servieoor Feeder Not Included, <br /> Each pnmp or irrigation circle $40.00 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 /> 215. FOR OWNI~R INSTALLATIONS F. Each additional Insp~tion <br /> Over the allowable in any of the <br /> above, per Inspection $35.00 <br /> Property Owner (pleaseprinO O. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each $50.00 <br /> Mailing Address Phone (sold only to electrical contractors) <br /> H. Other <br /> City/State/Zip (As required by Building OtticiaO <br /> Aurora Dwelling Electrical Fee . sq. fl. Jr $.06 = <br /> Owner's Signature: Dwelling Permit Label # of Labels N/C <br /> <br /> 5. FEES <br /> Al. Enter total of fees from Sec. #4 $~.~.. <br /> A2. Add 5% surcharge (.05 x Al) $_~.~..~ <br /> $ ~.. 75- <br /> 3. PLAN RgtVIliW SECTION Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> Marion County does not require a plan review. (Sec. 3), if required $. <br /> C. Investigation Fee (if required) $ <br /> We will provide plan review service if you complete D. Reinspection Fee ($25.00) $ <br />Section 5B and submit two (2) sets of plans and TOTAL AMOUNT DUE $ ~/o, <br />specifications with this application. Receipt No. <br />MC 15-34 12/94 <br /> <br /> <br />