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FOR CITY VALIDATION [ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPBCTION <br /> COMMUNITY DEYELOPMENT CENTER <br /> 285 Church St NE · Room 132 P[/NM[T NO. <br /> Salem, OR 97301 <br /> <br /> Date: <br />24 Hr Iesp~tiofl Li~ 588-7904 <br />Office: 588~5147 8:00a.m.-4:30pam <br />FAX: 588-7948 Issued <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through <br /> <br /> PERIVII~S ARE ~IoN-TRANSFERA~ILE AND EXPIRE IF WORK IS NOT [ <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />[ WORK IS SUSPENDED FOR 180 DAYS. <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Contractor's Board Reg. No. q5~3s t JobNo. <br /> _Sign ta ute of Supervidng El~¢trieim~ <br /> <br />211. FOR OWNER INSTALLATIONS <br />Property Owner (p/ease print) <br /> <br />Mailing Address I Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN RtlVIEW 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-J4 12/94 <br /> <br />4. FEB 8CHtlDULE (Complete and enter total in Al below) <br /> Number of Inspections per permit allowed ~ <br />A. <br /> Re~demial <br /> P~ <br /> U~it <br /> Ikevi~ lnelud~t: lt~lm Cost(each) Sum <br /> 1000 sq. fl, or le~ $85.00 4 <br /> Each additional 500 sq. ft. <br /> or pertion thereof $15.00 <br /> Limited Energy $20.00 ,1 <br /> Each Manufactured Home or Modular <br /> Dwdling Service or Feeder { $40.00 <br /> <br />B. 8~'vi~ ~r Feeder ~ (Do~ not inelud* branch circuits, see section D) <br /> <br /> 200mmpaorl~a $50.00 II.Ad, 2 <br /> ~01 empa to 400 araoa $60,00 2 <br /> 401 amp to 600 amp $100.00 2 <br /> 601 amps lo 1000 amps $130.00 2 <br /> Over 1000 amps or volta $300.00 . 2 <br /> Remneel only $40.00 <br /> <br />C. T~np~'ary <br /> <br /> 200 aml~ or less 235.00 -- 2 <br /> 201 amps to 400 {unps $40.00 2 <br /> 401 amps to 600 amps $80,00 __2 <br /> Over 600 amps or 1000 volta <br /> <br /> EaCh branch ¢in:uit $ 2.00 <br /> Each add~tinnul branch ¢imuit $ ZOO <br /> <br />Il. Miseellaneous (~vioeer Feeder Net Included) <br /> Each pump or inlgation circle <br /> Each sign or outline lighting <br /> Signal clrcupls) or a limited energy <br /> panel, aberation et ext~ion <br />F. E~Ch additional in~,~'tion <br /> Over the allowable in any of the <br /> above, per Inspe~tlon <br />O. Miner lemallation Labels <br /> Pack of l0 labels @ S5.00 each <br /> (sold oaly to el~tri~l ¢omrac~ors) <br />H. Other <br /> (As required by <br /> Aurora Dwelling Electrical <br /> Dwelling Purmit <br /> <br />$40.00 -- 2 <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> ~. g. x$./~ =__ <br /># of Lahais N/C <br /> <br />FEES <br />Al. Entar total of fees from Soo. ~4 <br />32. Add 555 surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% ofline Al for plan Review <br /> (See. 3), if r~quimd <br />C. Investigation Fee (if required) <br />D. Reinape~tion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ IS I;-° <br /> <br /> <br />