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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION I ~(~ <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 285 Church St NE . Room132 . --'" ~t~ ltl! <br /> Salem, OR 97301 PER~/j <br /> 24 Hr Inspection Lia~: 588-7904 MA - "-',--d -- <br /> omc,: 5884t47 s:0oa.m.-4:30p.m. /t810~1 COUNTy <br /> FAX: 588-7948 Issued <br /> .... ~ m&PEOTiON <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I Cross St. <br /> <br />Directions <br /> <br /> WO~ IS SUSP~D~ FOR 180 DAYS. <br /> <br />2A. CO~CTOR ~LATION O~Y <br />El¢ctricalCootractor ~ ~t~ <br /> <br />MallingAddress ~,O, ~OX ~B? ~O/~4'LO! <br />Pmperiy Owner ~/~'$~DI/O IlJ, ql~e0 I~I~ [ Phone <br /> <br />Contraclor's License No. 2.¥ <br /> <br />Ssiu~atrvlUr. s~r~fs SL~ c epon~s is ~. Eh ~r lc i~an~ ~~ <br /> <br /> 2B. FOR OWN-BR INSTALLATIONS <br /> Property Owner (pteeseprint) <br /> Mailing Address Phone <br /> City/State/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 15-34 12/94 <br /> <br />4. FEE SCHHDULE (Complete and enter total in Al below) <br /> Nmnber of Inspe¢lions per ponnit allowed -~ <br /> Unit <br /> mi <br /> Servic~ Included: ltem~ Cost (each) Su <br />!0~0 sq. fl, or less $85.00 4 <br />Each additional 500 sq. ft, <br /> or portion thereof $15.00 <br />Limited Energy $20.00 __1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />B. Set vin*s or Feeder ~ (Doe~ not include branch circuits, see section D) <br /> <br /> 200 amps or less $50.00 2 <br /> 201 amps to 400 amps $60.00 2 <br /> 40l amps to 600 amps $100.00 2 <br /> 601 amps to 1000 amps $130.00 2 <br /> <br /> Reconnect only $40.00 2 <br />C. Temporary Services/Fl~l*ra <br /> <br /> 200 amps or less $35.00 2 <br /> 201 amps to 400 amps $40.00 2 <br /> <br /> purchase of service of feeder fee <br /> Each branch circuit $ 2.00 <br /> <br /> b) The fee for branch circuits without <br /> ~urabaae of service or feeder lee <br /> Fit'~t branch circuit / $35.00 <br /> Each additional branch circ~fit $ 2.00 -- <br /> <br />E. Miscellaneous (Servine or Feeder NOt lneinded) <br /> Each pump or in'igation circle / ,~Zo~ ~$~' ~2 <br /> Each sign or outline lighting 2 <br /> Signal circuit(s) ora limited energy <br /> panel, alteration or extension $40.00 2 <br />F. Each additional lnapectlon <br />Over the allowable in any o£ the <br />above, per Inspeetinn $35.00 -- <br />O. Minor Inslallation Lnbels <br />Pack of 10 labels @ $5.00 each $50.00 __ <br />(sold only to etectHca l contractors) <br />H. Othe~ <br />(Az required by Building Olivia0 <br />Aurora Dwelling Electrical Fee __sq. fi. x $.06 = -- <br /> Dwelling Permit Label # of Labels. N/C <br /> <br />5. FEES <br /> Al. Enter total of fees fm~n Sec. g4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al rot Plan Review <br /> (See. 3), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspeetinn Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />