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FOR CITY VALIDATION Received by: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 5 1. LOCATION OF INSTALLATION 24 Hr Inapection Line: 588-7904 Oifico: 588-5147 8:00 a.m. - 4:30 p.m. FAX: 588-7948 PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WrTHIN 1 g0 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY Elect~oal Cont~cto~ ~,~.(CCCf,~6/a~a[ ~o,e ~ ~$ Contractor's License No. ~.ttt ~/O7C.. Contractor's Board Reg. No. .~O I Job No. SignatureofSuporvisingElectticianX ~ ~,~,..~ ~'~--ff~ Supervisor's Liccnse No. ~/~ ~"Y 1 Pho,e b~r¢-/yyy 2B. FOR OWNER INSTALLATIONS Property Owner (ple~ ~ print) Mailing Addr~s I Ci~/S~te/Zip 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. PERMIT NO: Date: r~ ~/ Issued by: 4. FEE SCHEDULB (Complete and enter total in A1 below) ~ A~ Residential Pex UnitNmnber oflnspsedons p~ ponnit allow,~./~-~ Servicz Included: Items Cost (each) Sum 1000 sq. fi. or less $85.00 4 Each additional 500 sq. ft. or portion thereof $15.00 -- Limited Energy $20.00 Each Manufactured Home or Modular Dwelling Setwiee or Feeder $40.00 2 B. Services or F~d~'s (Does not include branch circuits, ae~ section D) Installation, Air.atica or Relocation 200.mps o,i-- / 201 amps to 400 amps $60.00 2 401 amps to 600 amps $100.00 2 601 amps to 1000 amps $130,00 2 Over 1000 amps or volts $300.00 2 Reconnect only :$40.00 2 C. Tamporary Servlcea/Feede~s Installation, Alteration, or Relocation 200 amps or less $35.00 -- 2 201 amps to 400 amps $40.00 -- 2 401 amps to 600 amps $80.00 2 Over 600 amps or 1000 volts D. Branch Circuits N~v, Alte~atlons, or Exteni~on Per Panel a) lite fen for branch circuits wilh purchase of service of feeder fee Each branch circuit $ 2.00 -- b) The fee for branch circuits without purehasa of service or feeder fee First branch circuit $35.00 Each additional branch circuit $ 2.00 -- E. Miscellanemis (Sa'victor Feeder N~ Included) Each pump or irrigation circle $40.00 -- 2 Each sign oroutline lighting $40.00 __2 Signal circuit(s) or a limited energy panel, alteration or extension $40.00 -- 2 F. Each additional Inapzctlon Over the allowable in any of the above, per Inspection $35.00 -- U. Minor Installation Labels Pack of 10 labels @ $5.00 each $50.00 -- (sold only to electricM contractors) H. Other (As required by B~ilding ORiciaD Aurora Dwelling Electricel F~ sq. E. x$,06 = -- Dwelling Permit Label # of Labels NIC 5. FEES Al. Enter totalof fees fwm S~. #4 A2. Add 5% surcharge (,05 x Al) 8abtotal B. Eater 25% of line A 1 for Plan Review (Sec. 3), if required $ C. Investigation Fee (if r~quired) $ D. Reinspe~tion Fee ($25.00) $. TOTAL AMOUNT DUE S Receipt No.