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FOR CITY VALIDATION[ <br />Received 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. Inspection Line 373-44y/ <br />Office: Phone S88-S147 8:00am - 4:30pm <br />FAX: $88-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~ectlon$, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dil~tiom <br /> <br />PERMITS ARE NON-TRANSFERABLE AHD EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Flectrical Contractor [ Phone <br />Mailing Address <br /> <br />]l~oparty Owner [ Phone <br />Co~tractor's License No. <br />Contracior's Board Reg. NO. ] Job NO. <br />Signature of 5upervlsing Electrician <br /> <br />Phobia <br /> <br />2B. FOR OWNItR INSTALLATIONS <br />l~o~V~ Owner (p~pri~) ~'~O~/,k ~ ~1~ ~ <br />~'~ si~,:~~ <br /> <br />3. PLAN PJEVIEW 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 />4. ~1~ SCHEDULE (Complete and ~nt~ total in A1 below) <br /> Numbor of lmpeotiom p~ permit allowed <br />A. <br /> Re~idemiol <br /> Per <br /> Unit <br /> ~vin~ Ineldddd: Rema Co~t (eaoh) Sam <br /> 1000 sq. ft. or less $85.00 4 <br />Each additional 500 sq. ft. <br /> o~ poaion thereof $15.00 <br />Limited E~crgy $20.00 '~ 1 <br />Each Maaufactut'~d Roma or M~dula~ <br /> Dwelling Service or Fecd~ $40.00 2 <br /> <br />B. Servioe* ~ peeder a (Do~s not inelu& Iwaneh circui~ ao~ section D) <br /> <br />200 ampsor l~s $50.00 __2 <br />201 amps Io 400 amps $60.00 2 <br />401 amps to 600 ampa $100.00 2 <br />601 amps lo 1000 amps $130.00 2 <br />Over 1000 amps or volt~ $300.00 2 <br />Recom~ect only $40,00 2 <br /> <br /> 200 amps or lean $35.00 2 <br /> ~0l amps to 400 amps $40,00 2 <br /> 401 amps to 600 amps $80.00 2 <br /> <br /> a) The fee for branch el~u0s y~th <br /> .. <br /> Each branch circuit $ 2,00 ,~- <br /> <br /> First hameh Ycrcuit $35.00 <br /> <br />E. Miscellaneous (~r,/i~ ~ Feade¢ Not Ineludod) <br />Each pump or irrigation circle $40.00 2 <br />Each sig~ ot outtia~ lighting $40.00 2 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 .... 2 <br />F. ~ach additional lmp~ion <br />Over the allowable in any of the <br />above, per Impection $35.00 <br />Gl. Mioo~ Installation Labels <br />Pack of 10 labels @ $5.00 ea0h $50.00 <br />(sold only to el~trical contractors) <br />H. Other <br /> (As r~Iuired by ~uildi~ 08ici#l) <br /> Amora Dwelling Electrical Fe~ --~q. fl. x $.068 = -- <br /> Dwelling Permit Label # of Labels N/C <br /> <br />5, FEE S Al. Et~r total of fees from Sec. ~4 <br /> A2, Add 5% aurcharge (,05 ~c Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), ii'required <br />C. lnv~sUgafion l~e (if r · qu'tl'~d) <br />D. Rei~pection F~c ($25.00) <br /> <br /> TOTAL AMOUNT DU~ <br />Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />