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FOR CITY VALIDATION] <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE * Room 132 <br /> PERMff NO: <br /> Salem, OR 97301 <br /> <br /> Date: <br />24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: S88-794S Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION ] <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PF~.M1TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WO1LK IS SUSPFaNDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Job No. <br /> <br />Phone <br /> <br />Supervisor's License No. <br /> <br />liB. FOR OWNBR INSTALLATIONS <br /> <br /> Property Owner (ploas~print) <br /> Mailing Address / Phon~ <br /> City/State/Zip <br /> <br />:3. PLANRBVIBW 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 />4. NBE SUHBDULB (Completu and ente~ total in Al below) <br /> Number of Inspections per pe~mlt allowed -~ <br />A. <br /> Residential <br /> Unit <br /> 5ervloelncluded: ltums Coat(each) Sum I <br /> 1000 sq. ft, or less $85,00 4 <br /> ~ach additional 500 sq. n, <br /> or portion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feed~ $40.00 -- 2 <br /> <br />B. Service~ or Feeders (Does not includ~ branch ¢ircui~ ae~ s~tion D) <br /> <br /> 200 amps or less $50.00 -- 2 <br /> 201 amps to 400 amps $60.00 -- 2 <br /> 401 amps to 600 amps $100,00 -- 2 <br /> 601 amps to 1000 amps $130.00 <br /> Over 1000 amps or volts $300.00 -- 2 <br /> Reconnect only $40.00 2 <br /> <br /> 200 mnps or less $35.00 -- 2 <br /> 201 mnps to 400 amps $40.00 -- 2 <br /> 401 amps to 600 amps $80,00 <br /> Over 600 ~nps or 1000 volts <br /> <br />D. Branch Circuits <br />a) The fee for branch circuits with <br />Each branch circuit $ 2.00 <br /> <br />$35.00 <br /> <br />$ 2.00 -- <br /> <br />E. Miscellaneous (Service or Fo~dor Not Included) <br />Each pump or irrigation circle $40.00 2 <br />Each sign or outline lighting $40.00 2 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 2 <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, por Inspection $35.00 -- <br />G. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical cotltt~ctors) <br />IL Other <br />(As required by B~ilding Official) <br /> Aim)rs Dwelling Electrical Fee __ fq. fl. x $.068 - <br /> Dwelling Permit Label it of Labels N/C <br /> <br />5. FEES <br /> Al. 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 r~quired $.__ <br /> C. Investigation Fee (if required) $.__ <br /> D. Reinspeetion Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUll <br /> Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />