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FOR CITY VALIDATION <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 373-442'I <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />lob Addu~ <br /> <br /> PERIvffr$ ARE NON-TRANSFERABLE AND RXPIRE IF WORK IS NOT <br /> STAR'IT~) WITHIH 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />I~t~rty Owner ' I Ph~e <br /> <br />Contractor's Board Reg. No. ~<j~"~ <br />Signatur~ of Supervising El~tficia~ <br /> <br />liB. FOR OWNER INSTALLATIONS <br /> <br />3. PLANRBVIEW 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. FEE SCI-I]~[DUL~ (Complete and enter tolalin Al below) <br /> Number of lmpoctions p~ pea'mit allowed ---~ <br />A. <br /> Residential <br /> Unit <br /> ~vio~tnolud~d: ll~n~ Corot(each) Sum ! <br /> 1000 sq. it. or leas $85.00 4 <br /> Each additional 500 sq. ft. <br /> o~ portion thereof $15.00 <br /> Limited ~r~rgy $20.00 1 <br />~eh Manufactured Home or Modular <br />Dwelling S~rvice or Fm~der [ $40.00 2 <br /> <br /> B..~r vio~ ~r F~ler Is (Do~s not iacind~ branch circuits, ae~ s~etion D) <br /> <br />'-~0 amps o~ less $SBD0 ,., 2 <br />201 amps to ~ ~ $~.~ 2 <br />~1 am~ m ~ am~ $1~.~ 2 <br />~1 ~ps to 1~ ~ps $1~,~ 2 <br /> <br />R~ o~ ~ , 2 <br /> <br /> ~ ~ or ~ $35.~ , 2 <br /> ~1 am~ to ~ ~ $~ 2 <br /> <br /> a) ~e fee for b~ch ¢~ ~ <br /> ~ch branch ¢i~uit $ ~ <br /> <br />$35110 <br />$ 2.00 <br /> <br />E. Mi~linn~a (~e~vie~ or Peeder Not Included) <br />Each pump or irhgation circle $40.00 <br />Each fi~, or ouffme lighting $40.00 <br />Signal ¢imuil(s) or a limited energy <br />panel, alteration or exlemion $40.00 <br />F. Each additional Inspection <br />Owr the allowable in any of the <br />above, per lmp~ctinn $35.00 <br />O. Minor inst~lintion Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold oMy to electdcM ¢o~t~¢tors) <br />H. Other <br /> (As reqo/r~d by ~iIding Ot~i~l) <br /> Aurora Dwelling Electrical Fee . sq. fl. x $.068 = <br /> DwelFmg Pem~it L~el # of La~la. <br /> <br />2 <br /> <br /> 5. Iq~ES <br /> Al. Enter Iolal of fees from Sec. #4 <br />.~A2. Add5% surzha~g~(.05 xAl) <br /> <br />~btotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Se~. 3), if required <br />C. Inve~tigalion ~ (if requ'~d) <br />D. Reimpo~tion Fee ($35.00) <br /> <br /> TOTAL AIvlOUNT DUE <br /> Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />