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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> <br />Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am-4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Address <br /> <br />PERMITS ARE HeN-TRANSFERABLE AND F~XPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAyS OF ISSUANCE OR IF <br /> WORK IS SUSPF~/DED FOR 180 DAYS. <br /> <br />2A, COHTRACTOR INSTALLATION ONLY <br /> <br />Con~actor'sBoa~R,gNo. ~?ql7 ~ <br />Sig~mre of $up~m~ing El~c~icia~~ <br />Supe~isor s Lice~c No. ~7Z~ <br /> <br />Phone <br /> <br />2B. FOR OWHER INSTALLATIONS <br /> <br />Prot~rty Owner (pl~ print) <br /> <br />Mailing Address <br /> <br />City/StaU~/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN RBVIEW SECTION <br /> <br />Date: <br /> <br />Issued by: <br /> <br />IMarion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 50 and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br /> MC 15-341/96 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A l below) ~ <br /> Ntunbcr of Inspections per permit allo~ -~ <br /> Unit <br /> <br />1000 sq. fi. 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 [ q~ ~ <br />B. Services or F~t~ (Does not ~nclude branelt circuits, see section D) <br /> <br /> 200 amps or less _~ $50.00 2 <br /> 201 amps to 400 amps SilO.00 __2 <br /> 401 amps to 600 amps $100.00 -- 2 <br /> 601 amps to 1000 amps $130.00 __2 <br /> Over 1000 amps or veils $300.00 2 <br /> Reconnect only $40.00 -- 2 <br /> <br /> 200 neaps or less $35 BO 2 <br /> 201 amps to 400 amps $40.00 2 <br /> 401 *anp~ to 600 amps $80.00 -- 2 <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Circuit* <br /> <br /> a) The fee for branch circuits ~ <br /> pJ!r~ase of service of feeder fee <br /> Each branch ¢itctht $ 2.00 <br /> <br />b) The fee for branch circuits without <br /> <br />Fhst branch circuit <br />Each additional bnmch circuit <br /> <br />$35.00 -- <br />$ 2.00 -- <br /> <br />E. Miscellaneous (8~'vice or F~det Nnt Included) <br />Each pump or irrigation circl~ ~.~ 2 <br />~ch si~ or outline li~fing ~.00 2 <br />Sign~ circuit(s) or a limit~ energy <br />panel, sit.alien or extemion $~.00 2 <br /> <br /> Over the allowabl~ in any of~e <br /> above, ~r l~p~ction $35.~ <br /> <br /> P~kof tO labels ~ $5.~ ~ch $~.~ -- <br /> (sold only to el~trice l contractors) <br /> <br /> (~ reqmred by Buildi~ O~c~D <br /> Aurora Dwelling Electrical Fee ~sq. ~. x $.068 = ~ <br /> ~elling Pe~it ~bel g of ~ <br /> <br />5. FEES <br />Al. Entar totalof£ees from See. g4 $ <br />A2. Add 5% surcharge (.05 x Al) $ <br />~ubtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br />(Sec. 3), if required $ <br />C. Investigation Fee (if required) $ <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br /> <br />