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FOR CITY VALIDATION <br />R~iwd by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPltCTION <br />COMMUNITY DEVELOPMF31T CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Insp~tlon Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 585-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all ~ections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ~$ A~ NON-~S~B~ AND ~ ~ WO~ 18 NOT <br /> ST~ ~ 1 ~ DAYS OF 1S$U~ OR ~ <br /> WO~ IS SUS~D~ FOR 1~ DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Proper~y Owner (pleas~print) <br /> <br />Job No. <br /> <br />P~lone <br /> <br />Mailing Address <br /> <br />CitylStat-JZip <br /> <br />Owner's Signature: <br /> <br />3. PLA.~ RB¥1EW SHCTION <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 />BUILDIN(I INSPECTION <br /> <br />4. ~ SCHEDIJLlt (c~pt~t~ aaa ~ ~ m At <br /> N~b~of ~t~ns <br /> ~it <br />~ Rmid~tlal P~ Unit p~ ~ <br /> <br /> ~ ~ ~f $15.~ <br />L~i~ ~ $20.~ I <br />~ch Manufactu~ H~e or Mo~ <br /> <br /> ~1 ~ to ~ m~ $~.ffi 2 <br /> <br /> ~t ~ly ~.~ 2 <br />C, T~p~ary ~s <br /> <br /> 201 amps to ~ ~ ~.~ 2 <br /> a) ~* fee for bm~h ~ui~ ~ <br /> <br /> b) ~l~e fee for Imm0h cimuits ~ <br /> <br /> FirSt branch circuit ] <br /> Each additional branch circuit <br /> <br />E. Mia~dlaneeas (~evioo~r Fe~dor N~t In~ludM) <br /> E~h pump o~ ktigallmt clrdo <br /> Enab sign/ot~ufline lighting <br /> Signnl cCa~:uit(s) or n limited energy <br /> panel, alt~ation or extemion <br />F. Each additional In,pectins <br /> <br />O. Min~t lnetallatlo~ Labela <br /> Pack of 10 labels ~ $~.00 each <br /> (sold only to electrical co, factors) <br />14. Othe~ <br /> (A~ required by ~uildiqg O~cial) <br /> Aurora Dwelling Eleettieui Fee <br /> Dwelling ?ennlt Label <br /> <br />$ 2.OO <br /> <br />$ .ooCq 5cc <br />$ zoo <br /> <br />$4O.0O 2 <br /> <br />$4O.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> sq. fl' x $. 068 = -- <br />4' of Labeb N/c <br /> <br />FEES <br />Al. Fmter total o f fze~ from S~e. #4 <br />A2. Add 5% sutehar~ (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (ifr~luircd) <br />D. Reinspe¢lion F¢¢ ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> P.~euipt No. <br /> <br />MC 15-$4 1/96 <br /> <br /> <br />