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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> PERMIT NO: 9 ("~'"' 3/-//O <br /> <br />24 Hr Inspection Line: 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directions <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. CONTRACTOR INSTALLATION ONLY <br /> <br />Electric~~~ ~~l~_.~ eh°n~73'"-~l. 75 <br /> <br />Property Owner f~ t) j~-~{,- ]' ~,~0J~ Pho~7t~- ~'~ ZL3 <br /> <br />Job No. <br /> <br />Contractor's License No. ~:~t~ I .~ ~... <br />Contractor's Board Reg. No. <br /> <br />Supervisor's License No. , 315'$ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please prinO <br /> <br />Mailing Address J Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW 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 />4. FEE SCHWAB (Complete <br /> Numbe~l~S~S ~[~a~d ~ <br />A. R~idential P~ Unit OL~I~UtI~O [P~L~L~ J IUi¥ <br />~vi~ Inolud~: lte~ Cost (gach) Sum <br />1~ sq. ~. or less $85.~ 4 <br />~ch additional 5~ sq. ft. <br /> or ~Rion ~e~f $15.~ <br />Limited Energy $20.~ 1 <br />~ch Manufacmr~ Home or Modul~ <br /> Dwelling Se~ice or Feed~ $40.~ <br /> <br />B. Service~ or Feeders (Does not include branch cimuits, see section D) <br /> Installation, Alteration or Relocation <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 orvolts $300.00 __ 2 <br /> Reconnect only $40.00 __ 2 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alteration, or Relocation <br />200 amps or less $35.00 <br />201 amps to 400 amps $40.00 <br />401 amps to 600 amps $80.00 __ <br />Over 600 amps or 1000 volts <br />sec "B" above <br />D. Branch Circuits <br />New, Alterations, or Extension Per Panel <br />a) The fee for branch circuits ~ <br />purchase of service of feeder fee <br />Each branch circuit $ 2.00 __ <br /> <br />b) The fee for branch circuits without <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.00 <br />$ 2.00 <br /> <br />E. Miseellaneona (Service or Feeder Not Included) <br />Each pump or irrigation circle $40.130 __ <br />Each sign or outline lighting $40.00 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 <br />F. Each additional Inapeetion <br />Over the allowable in any of the <br />above, per Inspection $35.00 <br />O. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />H. Other <br />(As required by Budding OBTcial) <br />Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />__.sq. [L x $.06 <br /># of Labels <br /> <br />N/C <br /> <br />FEES <br />Al. Enter total of fees from Sec. ~ <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <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 12/94 <br /> <br /> <br />