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F(JR CITY VALIDATION Received by: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room ]32 Salem, OR 97301 24 hr. Inspection Line 3734427 Office: Phone 588-5147 8:00am - 4:30pm FAX: 588-7948 IELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALLATION ~obAddeeas ~$$2 H~,lt~t, rr Re, ~. ~S A~ NON-~NS~B~ AND ~1~ W WO~ 15 NOT WO~ I$ SUSP~ FOR 1~ DAYS. ~ CO~CTO~ ~LATIO~ Mailing Address Signature of Supervising Electrician Supervisor's License No. 2B, FOR OWNER INSTALLATIONS MailingAddrezs ~ ~j~J~'~ mone 7~T'IO f~ Ovmer's Signature: t~'~ 3. PLAN REVIEW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. Issu~ by' MARION COUNTY 4. FEE SCHEDULE (Compiele marl em~ totalln Al below) Nmnber of In~p~tions per parmit allowed -~ A. Redidonllal Unit 8ervio~ Included: Items C~t (e~ch) gum 1000 sq. fL or less $85.00 4 F. aeh additional 500 sq. ft, o~ portion thereof $15.00 -- L/mailed Energy $20.00 __1 .Each Manufactured Home or Modular l~eiFmg Set:let or Feede~ $40.00 2 B. Services of Feedera (Does not include branch circuits, see seerJ, on D) 200 amps or less $50.00 -- 2 201 maps to400 amps $50.00 __2 401 amps to 600 amps $100.00 -- 2 601 amps to 1000 amps $130.00 -- 2 Over 1000 amps or volts ,~00.00 Reconnect only $40,00 2 C. Temporary Sefvioe~/Feede~ 200 amps or le~ $35,00 -- 2 201 amps to 4~0 amps ~40.00 -- 2 401 ampa to 600 ampa $80.00 __2 Over 600 mnpa or 1000 volts D. Branch ~ircoit! a) The fee for branch circuits ~ purchase of servic~ of feeder feg Each branch circuit $ 2.00 -- b) T~e fe,~ for branch circuits without First branch circuit Each additional branch circuit E, Mi~cuilaneous (Servioeor Feed~ Ho~ included) Each pump or ~rigation ch'cie $40.00 Each sign or outline lighting $40.00 :Signal circuit(s) or s limited energy panel, alteration or extension $,10.00 F. E~Ch additional inzpee~ion Over the allowable in any of the above, i~r Inspection $35.00 O. Min~ Installation L~beh Pack of 10 labels @ $5.00 each $50.00 (~old only to electrical contractors) lt. Othe~ (A~ required by Building O~¢ial) Amora Dwelling Electrical Fee ~q. fr. x $.068 = Dwelling Permit Label # of Labels 5. FLIES A 1. Enter total of fees from Sec. fi4 A2. Add5% surcberge (.05 x Al) Eabtoeal $ B, Enter 25% of line A1 for Pian Review (See. 3), if required C, Investigation Fee (if required) D. Reinsl~ction Fee (~5,~) ~$~ ~T~ ~0~ D~ Receipt No.