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FOR CITY VAI.FDATION[ <br />Rc~eD~l by:. _ . [ <br />]~te: [ <br /> <br /> MARION COUNTY <br />· !BUILDING INSPECTION DIVISION <br /> 3150 LANCASTER DR NE - SUITE C <br /> SALEM OREGON 97305-1398 <br /> <br /> 24 ht~ InsPeCtion Line 373-4427 <br />Office: Phou~ 58&-S1~7 S:00am - 4:~pm <br />FAX: S88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ail ~ections, I through <br /> <br />~ L~ATION OF I~[STALLATION <br /> <br />PF. RM1TS AR~ NON-TRANSFERABL!~ AND EXPIRE IF WORK IS NOT <br />STARTED ~ 180 DAYS OF ISSUAN(~ OR IF <br /> WORK IS SUSPRNDED FOR 180 DAYS. <br /> <br />:lA. CONTRACTOR INSTALLATION ONLY <br /> <br />Phonc~ <br /> <br />{Fax~ <br /> <br />Property Owner <br /> <br />Signature of Supervising Elcc~ci~ <br /> <br />Supcrvisor's Lice~.s~ No. <br /> <br />Phone// <br /> <br />2B. FOR OWNRR INSTALLATIONS ~c~,~,- <br /> <br />Mailing Address 3373'~ ~ ~r, . ~ <br /> <br />~'s S [gustu~e: <br /> <br />3. PLANI~I¥~W SBCTION <br /> <br />Marion Cotmty does not require a plan review.. <br />We will provide plan review sen, ice if you complete <br />Section 5B and subnlit two (2) sets of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> 2 <br /> .~1 aml~ to 400 amps $60.00 <br /> 401 amp~ to 600 amt~ $ lO0.O0 2 <br /> 601 aml~ to I000 amp~ $130.00 <br /> Over I000 ~ or ~olL~ $300~0 2 <br /> Reconnect only $40.00 -- 2 <br /> C. T~n~m'ar y ~'ntiee~Feede~ ~ <br /> <br /> 2~0 ampa or leaa $35.00 __2 <br /> 201 aml~ to 400 amln $40,00 2 <br /> 401 sml~ to 600 amln $80.00 __2 <br /> <br /> D. Branch CireURs <br /> l'~w, Alte~atlons, or l~:~e~sion pec Pand <br /> ~) The fee for brmeh eireui~ <br /> <br /> Each branch e~euit $ 2.00 -- <br /> b) The fee fo~ bcaneh elrcuit~ without <br /> <br /> F'a~t branch ekeult $35.00 <br /> Each ~Iditioug brs~ch circuit $ 2.00 <br /> <br /> r~ch pump o~ in'igatlon circle .~.~,/ $40.00 2 <br /> finch slgn or oatlia~ llghting ~ ~40.00 __2 <br />Slgaal ¢ircuR(j) or a limited energy' <br />panel, allera60a or extension $40.00 2 <br />F. Igach additional <br />Over the allowable in say of the <br />abov~ per lmp~inn $35.00 -- <br />G. Min~ ln~tallatio~ Label~ <br />P~¢k of 10 inb~h @ $5.00 e~b. $50.00 -- <br /> · (soldoalytoelt~trlc~lco~t~cto~) <br />H. Other <br /> (As required by Btdldit~g <br /> Aurora Dwell~g ~lceL4cal <br /> Dwelling Pcmlit L~I~I # Of Labels N/C _ <br /> <br />FEES <br />Al. Faacr total of fe~.~ from S~e.//4 <br />AL Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br />B~ En~r 25,% of Iiae Al for Phn Review <br /> <br />¢. ~ve~igatiofl r~ (i f requlr~) <br /> <br /> TOTAL AMOUNT DUB <br /> I~'~t No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />