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FOR CITY VALIDATION <br />Recoivod by: <br />Date: <br /> <br />MARION COUHTY 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 />I. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED W1THIN 180 DAYS OF ISSUAHCE OR IF <br /> WORK IS SUSPEND~ FOR 180 DAYS. <br /> <br />CONTRACTOR/NSTALLATION ONLY <br /> <br />Elecu'ical Contractor [ Phone <br /> <br />Mailing Addr~a <br />Propeny Owner [ Phone <br /> <br />Contractor's License No. <br />Contractor's Board Reg. No. I Job No. <br />Signatuto of Supervising Electrician <br />Superviaor'a Liccnae ]No. [ Phone <br /> <br />FOR OWHER INSTALLATIONS <br /> <br /> Ma,,, Adih . sss <br /> <br />/ <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 applicafon. <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. ~7]~1~ .~CH]]~DUL~ (Completo and enlcr ~1 ~ Al ~w) <br /> N~r of ~ ~ ~it al~w~ <br />~ R~d~tial P~ Unit <br /> ~ Include: <br />l~.fl,~l~ $85.~ .. , 4 <br />~ch addi~n~ ~ aq. fu <br /> ~ ~n ~e~f $1 <br />~mit~ ~ $20,~ ~.1 <br />M~ufacm~ H~e or M~ ~ -., <br /> <br /> ~ ~ or I~ $~.~ ,, 2 <br /> 201 ~ ~ ~.~ 2 <br /> ~1 ~to ~ ~ $1~.~ 2 <br /> ~1 ~ ~ 1~ ~ $1~.~ ~2 <br /> <br /> R~t o~y ~.~ 2 <br /> <br />Do <br /> <br />Tmnporary 8erviczs/Fzedera <br />Installation, Almration. or Rzioeation <br />200 ampa or I~a <br />201 ampz to 400 arapa <br />401 amps to 600 ampa <br />Over 600 ampa or 1000 volt~ <br />~ "]]' above <br />Branch Circuits <br />New, Altzrationa, or E~ion Por Pand <br />a) The fee for branch circuita with <br /> purclma¢ of aervice of, feeder fee <br />Each branch circuit ~'x~x _ <br /> <br />b) Thc f¢¢ for br~nch circnit~ ~ <br /> purch~¢ of ~r~i¢¢ or feeder f~ <br />F'mt branch circuit <br />Each additional branch circuit <br /> <br />$35.00 , , 2 <br />MO.OO __2 <br />sao.oo __ 2 <br /> <br />$ %00 __ <br /> <br />$35.00 <br />$2.00 __ <br /> <br />E. Miseellaneons (Servie~or Foedor Not Included) <br />Each pump or irrigation circle $40.00 .2 <br /> Each sign or outline lighting M0.00 -- 2 <br />Signal circuit(s) or a limited cncrg~ <br />panel, alteration or extenaion $40.00 2 <br />F. Each additional Inspection <br />Over th~ allowable in any of thc <br />above, per Impection $35.00 <br />O. Minor Inatallation Labels <br />Pack of 10 labels ~ $5.00 each $50.00 . . <br />(~ld only to electricM co, factors) <br />H. Oth~ <br />(As r~quired by Building Or,ciaO <br />Aurora Dwelling Electrical F~ <br />Dwelling Permit Lal~l ]N/C <br /> <br />__sq. fl~ x $.068 = <br /># of Labe[a. <br /> <br />5. FEES <br />Al. Eater to~al of feca from Sec. g4 $ <br />A2. Add 5% su~cEat~c (.05 xAI) $.__ <br /> ~btmal $.~ <br /> <br /> B. ~ter 25% of i~e A 1 for PI~ Re~w <br /> (~c. 3), if~q~ <br /> C. ~v~tiga~n Fee (if~u~d) <br /> D. Rci~ction Fee (~5~) <br /> <br /> TOT~ ~O~ D~ <br /> Receipt No, <br /> <br />MC 15-34 1/96 <br /> <br /> <br />