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FOR CITY VALIDATION[ <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 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />l. LOCATION OF INffrALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contracto~ <br /> <br />Address <br /> <br />Phon~ Faxg <br /> <br />Job No. <br /> <br />Signature of Supervising Electrician <br />Supervisor's IAcense No, ] Phone~ <br />2B. FOR OWITER INSTALLATIONS <br /> <br />3. PLAN REVIEW 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 />MC 15-341/96 <br /> <br />4. FEE SCHBDULB (Complete and enter total in A 1 below) <br />A. R~sidential P~ Unit Number of Inspections per permit allowed -~ <br /> ~rvieo Included: Roms Co~t (each) Su <br /> mi <br />1~00 sq. O. or less $85,00 4 <br />Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 I <br />Each Manufactured Hom~ or Modular <br /> Dwelling S~rvice or Feeder $40.00 2 <br /> <br />B. Set vices or peeder, p (Does not include branch ¢irouits, ae~ ~etion D) <br />~200 amps or less $50.00 2 <br /> <br /> 201 amps to 4(30 amps $60.00 -- 2 <br /> q01 amps to 600 amps $100.00 2 <br /> 601 amps to 1000 amps $130.00 2 <br /> Over 1000 amps orvolts $300.00 -- 2 <br /> Reconnect only $40.00 2 <br />hemporary 8erviees/Feedeca <br /> InstaEation, Alter atio~, or Relocation <br /> 200 amps or less _ ~ ~ $35.00 2 <br /> 201 amps to 400 amps $40.00 -- 2 <br /> 401 amps lo 600 nmps - ~ $80.00 __2 <br /> Over 6~0 amps or 1000 volt~ <br /> <br /> D. Branch Circuits <br /> New, Alteeatinns, or Extension Per P~nel <br /> a) The fee for branch circuits ~ <br /> p3L~hase of service of feedex leo <br /> Each branch ¢ire~lit $ 2.00 <br /> <br /> b) The foe for branch cir¢inta without <br /> purchase of service or feeder fee <br /> First branch ¢lscuit $35.00 <br /> Each additional branch circuit $ 2.00 <br /> <br /> E. Miscellaneous (8~rvieeor Feeds' No~ Inehded) <br /> Each pump or irrigation ¢irclo $40.00 -- 2 <br /> Each sign or ou0ine lighting $40.00 -- 2 <br /> Signal circuit(s) ora limited energy <br /> panel, alteration or exlemion $40.00 2 <br /> F. Each additional Inspection <br /> Over tho allowable in any of the <br /> above, per Inspection $35.00 <br /> O. Minor Installation Labels <br /> Pack of l0 labels @ $5.00 each $50.00 <br /> (sold only to electrical contractors) <br /> H. Othe~ <br /> (As required by ~tilding Offidsl) <br /> Aurora Dwelling Electrical Feo <br /> Dwelling Pennil Label <br /> <br /> sq. fi, x $.068 =__ <br /># of Labels N/C <br /> <br />5. FEES <br /> Al. Enter tolal of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtolal $.__ <br /> <br /> B. Enter 25% of linc A 1 for Plan Review <br /> (Sec. 3), if required $.__ <br /> C. Invesligation Feo (if required) $.__ <br /> D. Reinspeebon Foo ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE $.__ <br /> Receipt No. <br /> <br /> <br />