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FOR CITY VALIDATION[ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <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 />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directiom <br /> <br />PERM]TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WTI~IIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />MailingAddre~s ~).O, ~OX lC'SI ~ <br /> <br />Contractor's License No. '2/~1 '~ q ~:,~_..~ <br /> <br />Conlractor's Board Reg. No. qgq33 [ JobNo. <br /> <br />Supervisor's LicenscNo. ~:~% 3-~ one l(.~ fT(=,"~~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print) <br /> <br />Mailing Address I Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLANREVIIiW 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 />MC 15-34 1/96 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FI~B $CHE~ULB (Complete and enter total in Al below) <br /> Number of Inspections per permit allowed <br /> R~id~ntiai <br /> Unit <br />Servir~ Included: Items Co~t (each) Sum <br />1000 sq. ft. or less $85.00 <br />Each additional 500 sq. ft. <br /> or poriion thereof $15.00 <br />Limited Energy $20.00 ~.1 <br />Each Manufactured Home or Modular <br />Dwelling Service or Feeder I $40.00 <br /> <br />B. 5ervicee or Feeders (Does not include branch circuits, see section D) <br /> lnatallation, Alteration or Relocation ~ $50.00 /~j2~ <br /> 200 amps or less <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 /> Reeormeet only $40,00 __ 2 <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 20 ! amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 volts <br /> see "B" above <br />D. Branch Circuits <br /> New, Alterationa, or Extenaion Per Panel <br /> a) The fee for branch circuits ~ <br /> purchase of servi~¢ of feed0r lee <br /> Each branch circuit <br /> <br />$35.00 __2 <br /> <br />$~.00 2 <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. Miscellaneous (Service or Feeder Not Indud~l) <br />Each pump or irrigation circle $40.00 <br />Each sign or outline lighting $40.00 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension MO.00 <br />F. Each additional Inspection <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 Building OfficiaD <br />Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br /> sq. ft. x $. 068 = __ <br /># of Labels <br /> <br />N/C <br /> <br />5. FEES Al. Enter total of fees from See.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter25% of line Al forPlan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br />Receipt No. __ <br /> <br />57,2c-, <br /> <br /> <br />