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FR 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: 588-7904 <br />Off.ice: 588--5147 8:00 a.m.-4:30p,m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION J <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF. INhalanT, lUNa <br /> <br /> I <br />au STAYTON {c,~ s~ <br />Dm=~x,, N.E. CORNER AT BRIDGE CONSTRI~'TION <br /> <br /> SI~ <br />~ I~AS~VI~ <br /> <br /> PERMITS ARE NONzTRANSFERABLE 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 IN~rALLATION ONLY <br /> <br /> n BMrr no: <br /> <br /> Date: <br /> <br /> Iss~ by: <br /> <br />4. ]~E~, ~K::~:HJ~)UJJ~ (~Dl~te mid ,ntet-total inAl beJow) <br /> <br /> Number <br /> of Ilmp0~tiolm <br /> permirfillowed <br />A. Realdentlal Per Unit / <br />Servic~ Included: :: Items C.~t (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 1 <br />Each Manufactured Home or Mg~ular <br />Dwelling Service or'F~eder $40.00 2 <br /> <br />B: Servke~ or Eaedera (Doe~ nOt include branch ¢ir~ui~ aec section D) <br /> 200ampslne~allati°n'or lessAlterati°n:or Rt4aeation ~ $50.00 ~? <br /> 201 amps~toqO0 ~nl~ $60.00 __ <br /> 401 ~unI~ to600 ~al~ $100.00 <br /> 601 ~m~ to IOOO ~nl~ $I~0.00 2 <br /> Over 1000 an~ or voit~ $300.00 . <br /> Reconnect only ~40.00 2 <br /> <br />C. Tzmporary 5ervlem0Feedera <br />Installation, Alteration, or Rdoeation [ <br />200 amps or'less <br />201 amps to 400 amps <br /> <br />b) The fee for branch circuit~ wiltmut <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />E. Miseellanem~s (Servioz or Fzeder Not Included) <br /> Each pump or in'igation circl~ <br /> Each Sign or outline lighting <br /> Signal circuit(s) or a limited energy <br /> panal, alterntion or extension <br />F. Each additional Inspection <br /> Over the allowable in any of the <br /> above, per Inspection <br />O. Minor Installation Labzis <br /> Pack of 10 labels 0 $5.00 each <br /> (sold only to electrical co~tractors) <br />H. Other <br /> (As ceq~red by Buiidi~ Ot~ciM) <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label # of Labels <br /> <br />5. FEES Al. Enter total of fees from Sec.//4 <br /> A2. Add 5% surcharge 605 x Al) <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property ownec (p/e~s~ pri~) <br />Mailing Address J Phone <br />City/State/Zip <br />Owner's Signature: <br /> <br />3. PLANRBVIEW SECTION <br /> <br />Subtotal <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 />B. Enter 25% of line A 1 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 />$80.00 2 <br /> <br />$35.00 <br />$ 2.00 <br /> <br />$35.00 <br />$5O.OO <br /> <br />L x s. = <br /> N/C <br /> <br />MC 15-34 12/94 <br /> <br /> <br />