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FOR CITY VALIDATIONI <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <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 $88-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br /> fC/5-' <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF RqSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED W1THIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Electrical Contractor I <br /> <br />Oyatractor's Board Reg. No. <br /> <br />Signature of Supervising Electrician <br /> <br />No. <br /> <br />Supervisor's License No. [ Phone <br /> <br />2B. FOR OWNER 131STALLATIONS <br /> <br />3. PLA_N'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. ~]~ SCH~,DUL~ (Complete and emer totalinAl below) <br /> Number of ~pactions ~ ~it al~wed ~ <br /> R~d~tlal <br /> P~ <br /> ~vi~indud~: Ite~ ~t(e~h) S~ I <br /> <br />~ch ad~fional 5~ sq. fL <br /> ~ ~on ~f $15.~ <br />Limit~ E~r~ ~0.~ 1 <br />~ch M~ufact~ H~e or Mo~l~ <br /> <br /> ~ amps or le~ $50.~ 2 <br /> ~1 ~ to ~ amps $~.~ 2 <br /> ~1 ~ to ~ a~ $1~.~ 2 <br /> ~1 ~ to 10~ ~pa $I~.~ 2 <br /> Over 1~ amps or vol~ ~.~ 2 <br /> Rennet only $~.~ 2 <br /> <br />C. T~p~y ~$ <br /> <br /> 2~ ~ or le~ $35.~ 2 <br /> <br /> ~1 am~ to ~ amps $~.~ 2 <br /> Over ~ ~pa or l~ ~l~ <br /> <br />D. Bran~ Ckcuita <br /> <br /> a) ~e fe~ for bm~h c~ ~ <br /> p~hase of semite of fe~er f~ <br /> <br /> b) The fee for branch circuits without <br /> p~rehmse of service or feeder fee <br /> First branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (8ervkoor Foed~ Nm lnoludod) <br /> Each pump or inigntion circle <br /> Each sign or outfiae lighting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension <br />F. Each additional in~peetion <br /> Over the allowahl~ in any of the <br /> above, per Inspection <br />O. Min~ Installation Labels <br /> Pack of 10 labels ~ $5.00 each <br /> fsotd only to electrical contractors) <br />H. Othe~ <br /> (As required by Building O[liciM) <br /> Aurora Dwelling I~lectrical Fee <br /> Dwelling Permit Label <br /> <br />$ 2.00 -- <br /> <br />$ soogS'00 <br /> <br />$4O.OO 2 <br /> <br />~40.0O 2 <br /> <br />$35.00 <br /> <br />$5O.0O <br /> <br />--sq. fl. x $068 =__ <br /># of Lab~M NIC <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec. #4 <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 Foe (ifrequirzd) <br /> D. Reinspeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br />$__ <br /> <br />$__ <br />$__ <br />$__ <br /> <br />$__ <br /> <br />MC 15-341/96 <br /> <br /> <br />