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i/ <br /> <br />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 I <br /> I <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <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 />Electrical Contrnctor J Phone <br />Mailing Addrcas <br />Property Owner I Phone <br />Conlractor's License No. <br />Contractor's Board Reg. Ho. Job Ho. <br /> <br />Signature of Supervising Eleclxician <br />Supervisor's License No. I Phone <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLANREVIBW 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 />I~P~IIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULB (comple~ and enter toUl in Al below) <br /> <br />A. Reaidentinl Per UnitNumber of Inspcction~ per permit allowed -~ <br />Servic~ Included: Items Co~t (each) Start I <br />1000 sq. ft. or less $85.00 4 <br />Each additionnl 500 sq. ft. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 ~,l <br />Each Manufactured Home or Modular <br /> Dwelling Service or Fccder $40.00 __ 2 <br />Feeders (Does not include branch circuits, see section D) <br /> , Alteration or Relocation i <br /> 200 amps or less [ $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 /> Rcennnect only $40.00 __ 2 <br /> <br />C. Temperary Servieaa/Feeders <br />Installation, Alteration, or Rdoeation <br />200 amps or le~8 $35.00 __ <br /> <br />401 amps to 600 ~mps $80.00 __ <br />Over 600 ~unps or 1000 volts <br />see 'B" above <br />D. lk~nch Circuits <br />New, Aiteratioas, or lixtensiem Per Panel <br />~-- a) The fee for branch circuits with <br /> _~urchase of service of fccder fcc ~ <br /> Each branch circuit $ 2.00 <br /> <br />b) The fee for branch circuits without <br /> purclmae of service or feeder fcc <br />First branch circuit <br />Each sdditional branch circuit <br /> <br />$35.00 <br />$2.oo <br /> <br />E. Miece~n~s (Servioe or Feeder Not Inohjded) <br /> <br />Each4ig~ outline lighting $40.00 <br />Signal circuit(s) or a limited energy <br />panel, altcration or ex~nsion $40.00 <br />F. Rach additional Inapcctlon <br />Over thc allowable in any of thc <br />above, per Inspection $35.00 <br />O. Minor In~llation L~bd~ <br /> P~¢k of 10 label~ @ $:5.00 each $50.00 <br /> (~id only lo electrical contractors) <br />H. O~her <br /> (A~ requited by Buil~qg <br /> Amora Dwelling ElecU'i¢,q Fe~ <br /> Dwelling Permit L~bel <br /> <br /> sq. fi. x $. 068 = -- <br /># of I.~bel~ N/C <br /> <br />5. FEES <br />Al. Enl~r total of fee~ from Sec.//4 $ <br />A2. Add 5% surcharge (.05 x Al) $.__ <br /> Subtotal $.__ <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if rsquircd $.__ <br /> C. Investigation Fee (if required) $.~ <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $ <br /> Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />