Laserfiche WebLink
FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING.~PECTION <br /> COMMUNITY DEVELOPI~F~T CENTER <br /> 285 Church St NE · l~om 132 <br /> Salem, OR 97301 <br /> Date: <br /> 24 hr. Inspectinn Line 3'/3-4417 <br /> Office: Phone 588-51d7 $:00am - 4:30pm <br /> FAX: 588-7948 JSsuod by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I througl~ 5 <br /> <br />~l~ AOCATION OF INSTALLATION <br /> <br />PER/Vff~S ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WTrHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SusPP_NDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Property Owner ! Phone <br /> <br />Contractor's Board Reg. No. [ Job No. <br />Signatm~ of Supervising Electrician <br /> <br />Supervisor's License No. Phone <br /> <br />3. PLAN RISVII~W $1~CTION <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 SCHtiDULR (Complete and ~nter ~olal in Al below) <br /> <br />B. Sm'vices or Fee/era (Does not include branch circuits, ace section D) <br /> Installation, Alte~atlon ~ R~ocation I ~'~ <br /> 200 amp~ or le~ I $50.00 <br /> 201 mnp~ to 400 amt~ $6O.00 -- 2 <br /> <br /> 401 amps to 600 am~ <br /> 601 amps to 1000 amps <br /> <br /> R~oonnect only <br /> <br />C. Temp~ary .%rvioes/Feedm'a <br /> In~allation, Alteration, ~ Relocation <br /> 200 amps or le~ <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 volt~ <br /> <br />D. Brenda Clrouita <br /> N~w, Alterations. or Extaa~ion P~ Panel <br /> a) The fee for branch ¢ircuila ~ <br /> p~v&aa~ of ~ic~ of feeder <br /> Each branch circuit <br /> <br /> b) The fee for branch circuits without <br /> <br /> lr~st branch circuit <br /> Each additional branch circuit <br /> <br />E. Mi~ellane~ua (~r'~½~ or Fo~de~ N~ Ittoluded) <br /> Each pump or irrigation circie <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited enexgy <br /> panel, alteration or extension <br />F. Eada ~,ddaioaaI In~ee, tlo~ <br /> Over the eliowable in any of <br /> above, per Inspection <br />O. Minor Imnallation Labels <br /> Pack of 10 labels @ $5.00 ~ach <br /> (sold oMy to electrical cotgracwrs) <br />H. Oth~ <br /> <br /> (As required by B~iIding O~cial) <br /> Amora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />$100.00 __2 <br />$130,00 2 <br />~00,00 2 <br />$40.00 -- 2 <br /> <br />$35.00 -- 2 <br />$40.00 -- 2 <br />$80.00 2 <br /> <br />$ 2.00 -- <br /> <br />2.00 <br /> <br />$40.00 __ 2 <br />M0.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 -- <br /> <br /> ,~q.fi. x $.068 =__ <br />#ofLda~ NIC <br /> <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtotal $.__ <br /> <br />B. Enter 25% of line A 1 for Plan Raview <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. R~inspeclion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />