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FOR CITY VALIDATION1 <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 3734427 <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 />cm~ Su'¢=ffDin~dom: <br /> <br />PERM1TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br /> <br />Address <br /> <br />Property Owner Phone// <br /> <br />Contractors License No. <br />Contractor's Board Peg No. I Job No. <br /> <br />Signature of Supervising Electrician <br />Supcrvisor's Licerae No. <br /> <br />{ Phone~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Owner's Signatm'e: <br /> <br />3. PLANRBVIBW SECTION <br /> <br />IMarion 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 I5-341/96 <br /> <br />PERMIT NO: <br />Dato: <br />Issued by: <br /> <br /> FEB <br /> SCHEDULE <br /> (Complat~ and enter total in A1 below) <br />A. Reaidential P~ Unit Number of Inspections pe~ permit allowed --~ <br /> <br /> Service Included: llerm Co~t (each) S <br />1000 sq. ft. or leas $85.00 4 <br />Each additional 500 mt. ft. <br /> or portion thereof $15.OO -- <br />Limited Energy $20.00 __1 <br />Each Manufactured Home or Modular <br /> Dwelllog Service or Feeder $40.00 2 <br /> <br />B. IServieea ~ Feede~a (Does not include branch circuits, see section D) <br /> <br />Installation, Alteration e~ Relocation <br />200 amps or less $50,OO <br />201 amps to 400 amps $60.00 <br />401 amps to 6OO amps $ IOO.OO <br />601 amps to 1000 amps $130.00 <br />Over leo0 amps or volts <br />Reconnect only $40.00 <br /> <br />200 amps or l~s $35.00 -- <br />201 amps to4oo amps $40.00 -- <br />401 amps to 600 amps $80.00 -- <br />Over 600 amps or 10OO ye{ts <br /> <br />a) The fee for branch circuits <br />msrchase of service of feeder fee <br />Each branch circuit $ 2.00 -- <br /> <br />b) The fee for branch circuits without <br /> pure{mae of service or feeder fee <br />Fi~t brach circuit <br />Each additional branch circuit <br /> <br />E. Miscellaneous (Serviette Feedm' No~ included) <br /> Each pump or inigatlan circle <br /> Each sig~ or outline lighting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension <br />F. Bach additional Inspection <br /> Over the allowable in any oflhe <br /> above, per Inspection <br /> <br /> (As required by Building O[t~cial) <br /> <br />$35.~ -- <br />$2.~ <br /> <br />$35.00 -- <br />$5O.OO <br /> <br /> Jq' fi. x $,068 =__ <br /># Of Labels N/C <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />5. FEES <br /> Al. Enter Iotal of fees from See. g4 <br /> A2. Add5% surcharge (.05 xAl) <br /> ~ubtetal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (See. 3), if r~quired <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />