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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 373-4427 <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 />1. LOCATION OF INSTALLATION <br /> <br />lob Description: <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrica{ Contractor <br /> <br />Address <br /> <br />Phon~ Faxg <br />Proporty Owner Phone~ <br /> <br />Contmotors License No. <br /> <br /> Contractor's Board Re8 NO. { Job NO. <br />tSignatore of Supervising Electrician <br />Supervisor's License No. { Phoneg <br /> <br /> FOR OWNER INSTALLATIONS <br /> <br /> o <br /> <br /> ' ' . ' <br /> <br />ci~/S~p ~orvr~ ~ PToo~ <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 />MC 15-341/96 <br /> <br />4. FEE SCHEDULE (Complete and enter total M Al below) <br /> Number of Inspections per p~rmit allowed -~ <br />A. <br /> Residential <br /> Per <br /> Unit <br /> 1 <br /> <br /> 1000 sq. fl. or ]~ss $85.00 j <br />Each additional 500 sq. fl. <br /> or portion thereof $15.00 <br />Lhnited Energy $~20.00 __1 <br />Each Manufactured Hcme or Modular <br /> Dwelling Survice or Feeder :M0.00 _/.,~___ 2 <br /> <br />B. ~vioea or F~d~s (Does not include branch circuits, see section D) <br /> Installation, Alteration or Reloration <br /> 200 amps or less $50.00 -- 2 <br /> 201 amps to 400 amps $60.00 ~-- 2 <br /> 401 amps to t00 amps $100.00 __2 <br /> 601 amps to 1000 amps $130.00 2 <br /> Over 1000 amps or volts $300.00 2 <br /> Reconnect only $40.00 -- 2 <br /> <br /> 200 amps or less $35.00 -- 2 <br /> 201 amps to 400 amps $40.00 -- 2 <br /> 401 maps to 600 aml~ $80,00 -- 2 <br /> Over 600 ~anps or 1000 volts <br /> <br /> a) The fez for branch circuits with <br /> Each branch cimuit $ 2.00 / <br /> <br />b) The fee for branch circuits ~lott[ <br /> <br />First br~ach circuit <br />Each additional branch circuit <br /> <br />E. Mi~eollnneous (survlee or Foed~ Not ~elud~) <br /> ~ch pump ~ i~gat~n c~le <br /> ~ch ai~ or outline li~tMg <br /> $ign~ ciwuit(s) or a limited <br /> <br />F. Ea~ additional In~bn <br /> Over the allowable in ~y of ~e <br /> above, per ]mpection <br /> <br /> Pack of 10 l~cls ~ $5.~ ~ch <br /> (sold oMy to el~trica l contractors) <br /> <br /> (~ r~ired by ~il&~ O~ciaD <br /> <br />$35.00 <br />$ 2.00 <br /> <br />$40.00 2 <br />$4O.O0 -- 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />--~q- fi. x $. 068 = -- <br /># Of L~bels <br /> <br />5. FEES <br /> A i. Enter total of f~es from See.//4 <br /> A2. Add 5% surcharge 605 x Al) <br /> ~ubtotal <br /> <br /> B. Enter 25% oflina Al for PlanReview <br /> (See. 3), if r*qalmd <br /> C. Investigation Fee (ifrequivdd) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUIqT DUE <br /> Receipt No. <br /> <br />$. <br />$. <br /> <br />$. <br />$. <br />$. <br /> <br /> <br />