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FOR CITY VALIDATION I <br />Rcecivexl by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr lnq~ction Line: 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588~7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dh~ctiom <br /> <br />Dca¢fipllc~ ~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK lS NOT <br />STARTED WTrHIN l BO DAYS OF ISSUANCE OR 1F <br /> WORK lS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />211. FOR OWNBR INSTALLATIONS <br /> <br />Property Owner (please print) <br /> <br />Mailing Address t Phone <br /> <br />City/StategZip <br /> <br />3. PLAN REVIEW SECTION <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 />Date: <br /> <br />Issued by: <br /> <br />4. FI~[i SCHFaDUL]~ (Complete and enter tolnl in A 1 below) <br /> <br />B. S~tic~ ~r Feed~gff(Does not includ~ branch ci~'ulls, see section D)O~ [ <br /> <br /> Reconnect only $40.00 2 <br /> <br />$35.00~ <br /> <br />200 amps or less <br />201 am~ to ~0 ~ps $~.00 2 <br />~1 mn~ to ~0 ~ps $~.~ 2 <br /> <br />a) ~o fee f~ brach c~ui~ wi~ <br />~ch~e of s~iec of fc~cr fee <br />~ch branch c~uit ~ $ 2.~ <br /> <br />b) ~e f~ for ~neh eimui~ wi~ut <br /> <br />Fi~t brach cire~t $35.~ <br />~eh additionfl brach circuit $ <br /> <br />E. Miscellaneous (Service ~ Feeder Nc~ 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. Bach additional Inspection <br />Over thc allowable in any of the <br />above, per Inspection $35.00 -- <br />O. Minor Installation Labeln <br />Pack of 10 labels @ $5.00 each $50.00 -- <br />(sold oaly to electrieM co.tractors) <br />H. Othe~ <br />(As required by Building 01Ttcial) <br /> Aurora Dwelling Electrical Fee __~. g. x $.06 = -- <br /> Dwelling Permit l~b¢l # of Labels. N/C <br /> <br />5, FEES <br /> A 1. Enter total of fees from Se~. fi4 <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 required <br /> C. Investigation Fee (if required) <br /> D. Reimpeellon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />MC 15-34 12/94 <br /> <br /> <br />