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FOR CITY VALIDATION] <br />Received by:__ ] <br />Date:~.~~ <br /> <br />~ob AdOr~ 7849 <br /> <br />MARION COUNTY BUll,DING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHhN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INgTALLATION ONLY <br />~e¢~dcal ConUactorXL ELECTRICS391 - 9113 <br /> <br />Property Owner { Phon~ <br /> <br />Cona'aetor's License No. 2 4 - 2 6 9 C <br />Contractor'a Board Reg. No. I 0 9 4 3 2 { lob No. <br /> <br />Signature of Supervising Electrician <br /> <br />Supervisor's License No. 2 4 8 1 <br /> <br />2B. FOR OWNER Ilq'STALLATION$ <br /> <br />Property Owner (please print) <br />Mailing Address ] Phone <br />City/State/Zip <br />Owner's Signature: <br /> <br />3. PLAN REVIBW SBCTION <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 1/96 <br /> <br /> 24 hr. Inspection Line 373~4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. F~E SCHI~DUL~ (Completa and ~ter total ia Al bebw) <br /> <br />~ R~id~tial P~ Unit N~b~of~et~ns p~p=~t ~wed ~ <br /> <br /> ~vi~ In~d~: It~ C~t (e~h) 5~ <br />1~ ~. fl, ~ I~ $85.~ 4 <br /> <br />~ ~on ~e~f $15.~ <br />~mitad Enemy ~.~ 1 <br />~ Manufacm~ Home or Modular <br />~ell~g S~ice or Feed~ 3 ~.~ 4 0 2 <br /> <br />B. S~ ~ F~a ~s aot ~cIMe ~nch ci~ s~ s~n D) <br /> <br /> Installation, .Mteration or Relocation <br /> 200 amps or lena $50.00 <br /> 201 amps to 400 amps $60.00 -- <br /> 4Ol amps to 600 amps $100.00 -- <br /> 601 amps to 1000 ~nps $130,00 -- <br /> Over 1000 ampa or volts $~00.00 -- <br /> Reconnect only $40.00 <br /> <br />C. Temporary Servlees/Feed~s <br />Installation, Alteration, or Relecatiea <br />200 amps or less $35.00 <br />201 amps to 400 amps $40.00 -- <br />401 amps to 600 amps $80.00 <br />Over 600 amps or 1000 volts <br /> <br />D. Branch Circuits <br />N~v, Alterations, or Exteaaien Per Panel <br />a) The fee for branch eircuRs ~ <br />purchase of service of feeder fee <br />Each branch circuit $ 2.00 <br /> <br />b) The fee for branch circuits without <br /> purchmse of service or feeder fee <br /> <br />$35.00 <br />$ 2.00 __ <br /> <br />E. MiseeEaneous (Servicoor Feeder Nd Included) <br />Each pump or inigation circle $40.00 <br />Each sign or outline lighting $40.00 -- <br />Signal cireuil(s) or a limited ene~*y <br />panel, alteration or extension $40.00 <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, per Inspection $35.00 -- <br />O. Minor Installation Labels <br />Pack of 10 ichela @ $5.00 each $50.00 -- <br />(sold only to electrical cotacactors) <br />H. Other <br />(As requirvd by Buildit~g <br /> Aurora Dwelling Electrical Fee sq. fl. x $.068 = -- <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 />N/C <br /> <br />5. FEES <br />Al. Entert~taloffeesfxomSe~.g4 $ ~0.00 <br />A2. Add 5% surcharge 605 x Al) $2.00 <br /> Subtotal $.__ <br /> <br /> B. Enter25% of lineAl for PlnnRevinw <br /> (See. 3), if required $.__ <br /> C. Investigation Fee (if requ/red) $.__ <br /> D. Reinspection Fee ($25.G0) <br /> TOTAL AMOUNT DUE $ 4 2. O, 0 <br /> Receipt No. <br /> <br /> <br />