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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />MARION COUNTY BUILDIN~ INSPECTION~/~ ~F~... <br /> COMMUNITY DRVELOPMENT CENTER 11114 <br /> 285 Church St NE ' Room 132 <br /> Salem, OR 97301 /~0 ~/ ~ / · t · <br /> <br /> · D to: <br /> 24Hr Inlq~:tlon Lino: 588-7904 ~,.. <br /> · on' s:OOa...-4aop . . <br /> FAX: ~88-794~ <br /> · ~'~llO]~ <br /> <br />I Please complete all Sections, I through <br /> <br />Dkectiom <br /> <br /> pERM1TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK I$ NOT <br /> STARTED W1THiN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Contractor's License Ho. <br />Contractor's Board Reg. No. 94~l j 1ob.o. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Properly Owner (ple~s~ primo <br /> <br />Mailing Address [ Phone <br />Cily/StntdZip <br />Owner's SJgnaturo: <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 />4. FEB SCHNDUI.B (Complete nnd *nter total in A1 below) <br /> Nmnber of ln~tlona i~r permit nllowed ~ <br />A. <br /> Per <br /> Unit <br />~lnelud-.4: Items Co~t (~e~h) Sum J <br />1000 8q, fl. or kas $85,00 4 <br />E~h edditiond ~ sq. fL <br /> or pofllofl thereo~ $15.60 <br />Limi~od nner~ $20.0O 1 <br />Each Mnrmfnctured Heine or Modular <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />B. ~rviees ot Pe~lers (Does not include branch circuit~, see aeetion D) <br /> <br /> Installation, Aheratioa or <br /> 200 nmp~ or less $50.00 <br /> 201 aml~ Io 400 amps $60.00 <br /> 401 amps Io 600 amps $100.00 <br /> 601 an~ lo 1000 ~mps S 130.00 <br /> Over 1000 amps or <br /> Reoonnect only $40.00 <br /> <br />C. Temporary ,~erv/e~/Peed~s <br />In~talhtion, Alteration, or R~tion <br />~0 mnl~ or le~ $35.00 <br />~01 sml~ to 400 aml~ $40.00 <br />401 ~ to 600 aml~ $80.00 <br />03~' 600 mups or lOOO rolls <br /> <br /> New, Alt~ratlons, <br /> e) Tho fee for btmch ¢ir~ults <br /> <br /> ~ach branch ¢~rcult $ 2.00 <br /> <br /> b) ~ fee for brauch circuits without <br /> <br /> First branch clmuit <br /> F~h add~tionM branch clrguit $ 2.00 <br /> <br />E. Mim~blneoua (Se~vlee m~ Feeder Not lnolud~d) <br />~teh pump ~(' irdpfion c/role $40.00 <br />F.~& siga or outliao light,S MO .iX) <br />Signal ci~uil(~) or a limited gnergy <br />pand. nltefntioo or extemi~n $40.00 <br />F. Baeh ~dditional Inspe~tknl <br />Over the allowable in any of Ihe <br />above, p~r lmpection $35,00 <br />CI. Minor Installation Lab*Is <br />Pa~k of 10 l,bob O $5.00 ,~r,h $50.00 <br />(~old otlly to electt~al cordraetors) <br />H. OIIwe <br />(As r~quiced by Building O~deiM) <br />Aurora Dwelling Electrical F~ <br /> Dw~llinff Permit L~bel <br /> <br /> ~q.~.x$.~ = __ <br />#of Latch ~ <br /> <br />5. FI~E8 Al. Enter totalof foe~ from Sec. #4 <br /> A2. Add 5% surcharge (.05 x At) <br /> <br />Subtotal <br /> <br />MC 15-34 12A~4 <br /> <br /> <br />