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FOR CITY VALIDATION <br />Re~eiv~i by:. <br />Date: <br /> <br />MARION COl)NTT BUILDING INSPI~CTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Chu~h St NE · Room 13.2 <br /> Salem, OR 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF IN~TrALLATION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br /> 4. [~]~ ~CHF:~DIJL~ (Compl~t~ aud enter total in A1 below) <br /> Number of Inspections ps permit allowed <br /> A, <br /> R~idential <br /> Unit <br /> ~rvle~ Included: Items Coal (each) Sum <br /> 1000 sq. fl. or less $85.00 <br /> .Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br /> Limited Energy $20.00 <br /> Each Manufactured Home or Modular <br /> Dwelling Service or F~der J $40.00 <br /> <br /> B..~rvie~s or Feeders (Does not include branch circuits, see section D) <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IP WORK IS NOT <br />STARTED ~ 1 ~} DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A~ CONTRACTOR INSTALLATION OHLY <br /> <br />Phoneg <br /> <br />Propsrty O~ner <br /> <br />Faa <br /> <br /> Phoaeg <br /> <br />Con{~actors License No. <br />Contractor's Board Reg No. J Sob No, <br /> <br />Signature of Supervising Elec=iciaa <br />Supervisor's Liceme No. J Phone~ <br /> <br />2B. FOR OWNBR Hq'STALLATION8 <br />P~p~rty Owner (plass~ print) ~-') a ~ ; e J ~, ~l'ramo,~s <br /> <br />3. PLANILBVIBW SBCTION <br /> <br /> 200 amps or less $50.00 2 <br /> 201 amps lo 400 amps $60.00 2 <br /> 401 amps to 600 amps $100.00 2 <br /> 601 amps lo 1000 amps $130.00 -- 2 <br /> Over 1000 amps or vol~ $300.00 -- 2 <br /> Reconnect only $40,00 2 <br /> <br />C. Temporary ~'vi~F~le~s <br /> <br /> 200 amps or less $35.00 -- 2 <br /> 201 amps to 400 am~ $40~00 -- 2 <br /> 401 amps to 600 amps $80.00 2 <br /> Over 600 amps or 1000 veils <br /> <br />D. Branch Cireult~ <br />a) The fee for branch ~ircuita <br />Each branch circuit $ 2.00 -- <br /> <br /> b) The fee for b~anch oimuite witho~ <br /> p3jxflhaae of aervlee or feeder <br /> Fwst branch circuit $35.00 -- <br /> Each additional branch circuit $ 2.00 -- <br /> <br />l~. Miscellaneous (~rvi0~ or F~d~ No~ lnoind~d) <br />Each pump or irrigation circle $40.00 -- 2 <br />Each sign or outlin~ lighting $40.00 -- 2 <br /> Signal circuit(s) or a limited energy <br /> psne~, alteration or extension $40.00 <br />F. Bach additional lnap~tion <br />Over the allowable in any of tbe <br />above, per Inspection $35.00 -- <br /> <br /> Pack of 10 labels @ $3.00 each $50.00 -- <br /> (sold only to electricM contractors) <br /> <br /> (As requited by Buildit~ O~¢ial) <br /> Auwta Dwelling Electtlcal F~e sq, ft. x $.068 = <br /> Dwelling Permit Label # of Labels N/C <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 />FEES <br />Al. Enter total of fees from See, #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtolal <br /> <br />B. Enter 25% of line Al for Plan Review <br />(See. 3). if required $.__ <br />C. lnv~tigatlon Fee (if required) $ <br />D. Reinspeetinn Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $.__ <br />Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />