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Received by:. <br />I Date: <br /> <br />VALIDATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> Salem, OR 97301 <br /> <br /> Date' <br />24 Hr lnapmtion Lin= 588-7904 <br />Off'gee 588-5147 8:00mm.-4:30p.m. <br />PAX: ~SS-?~S Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />~ob Add~ ~ <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 />Co.tra¢,or'.Lice.s* No. $ 7 ~ <br />Contracior's Board Reg. No. ~_ [ Job No, <br />Signature of Supervising Electrician <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> Mailing Address [ Phone <br /> City/Stsc/Zip <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 />MC t5-34 12/94 <br /> <br /> 4. FEit SCHEDUL~(Uomplet~andemerlotelinAl below) <br /> Number of Inspections per permit allowed -~ <br />A. <br /> R~identiel <br /> Unit <br /> l <br />'%-8m-vle. eIncduded: Ite~.~ Cost (each) Sum I <br />I000 sq. ti. or less q~ $85,00 4 <br />Each additional $00 sq. fL <br /> o~ portinn thereof $15.00 -- <br /> Limited Energy $20.00 __1 <br /> r-ch Manufactured Home or Modular <br /> Dwelling S~rvice or Feeder $40.00 2 <br /> <br /> B. g~vio~ or P~l~r s (Do~ not include branch ¢iguit~, see section D) <br /> <br />Io~taJlatina, AJteratina, or Relooatlon <br />200 aml~ or leas $35.00 __ <br />201 amps to 400 amps $40.00 <br />401 amps to 600 amps $80.00 -- <br /> <br />b) Tho lc0 fc~ branch circuils without <br /> purch~e of service or fee.~er fee <br />Fitst branch circuit <br />Each additional branch circuit <br /> <br />$35.00 -- <br /> <br />E. Mise~inne~ms (Servie~ or Feeder Not lneludud) <br />Each pump or inigatinn circle $40.00 -- <br />Each sign or outline lighting $40,00 -- <br />Signal circuit(s) or a Ihnited energy <br />panel, alteraticn or exlension $40.00 -- <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, per Inspection $35.00 -- <br />O. Minor In~tailatlon Labels <br />Pack of 10 labels @ $5.00 each $50,00 -- <br />(~ld on~y to electrical contractors) <br />H. Other <br />(As required by Boilding Official) <br />Ataorn Dwelling Electrical Fee __sq. 1[ x $06 = __ <br />Dwelling Permit Label # of Labels. <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br /> <br />2 <br /> <br />NIC <br /> <br />5. FEES Al. Enter total of t~es fiom Sec. #4 <br /> A2. Add 5% sugharge (.05 xAl) <br /> <br />8obtotal <br /> <br />B. Eater 25% of line A 1 for Plan Review <br />(Sro. 3), if required <br />C. lnv~figatinn Fee (if r~quired) $.__ <br />D. Reinapection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $.__ <br />Receipt No. <br /> <br /> <br />