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MARION COUNTY BUILDING INSPECTION ~ 9 ~ ~)~ ~ <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> FOR CITY VALIDATION 285 Church St NE - Room 132 pI=RMIT NO: <br /> <br /> Received by:., Salem, OR 97301 <br /> <br /> .... ' ~ 'on Line 373-4427 <br /> Issued by:- 4'30pm <br />E--'-~CTRICAL PERMIT APPLI <br />Ple~ecompleteall Sections, 1 tl~roug~ ~.~ 5 ~TF~HEDULE(Compicteandenter~otalinAlbelow) <br /> _ MARl~t~ Numbcroflnspectionsp~rpermitallowed <br /> <br /> LOCATION OF INffI'ALLATION ~Ul/~ ,,_0~'~ '~/A' Re~id*ntinl Per Unit <br />1. <br /> h-uhVG II~to,, 5ervi~lneluded: Items Coat(each) Sum <br />-- "-/'x. ~ Fx ~ ¼ . t _ ~ '/~0~) sq. ft. or less $85.00 <br />Job A~dress °~/~gh additional 500 sq. ft. <br /> ~) - or portion thereof $15.00 <br /> Limited Energy $20.00 <br /> Each Manufactured Home or Modular <br />Cro*s Street/Dire~fiom: Dwelling Service or Feeder $40.00 -- <br /> <br /> · E. 8~rv~s or l%~der s (Do~s not include branch ¢ffcuits, ~ee section <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Installation, Alteration or Relooation <br />2OO~,m? or 1~ -~ <br />201 ~ <br /> <br />~ am~ or le~ <br /> <br />b) The fee for branch circuits without <br /> _tmrchaae of service ~ feeder fez <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />Pmporty Owner (pier'print) <br /> <br />Mailing Address J Pheoe <br />City/State/Zip <br /> <br />Owner's Signature: <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 I <br />Section 5B and submit two (2) sets of plans and I <br />specifications with this app~ <br />MC 15-341/96 <br /> <br />Fimt branch circuit <br />Each additional branch cimuit <br /> <br />E. Miscellaneous (S~rvieeor Feeder Nc~ Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited energy <br /> <br />P. Each additional Inspection <br /> Over th~ allowable in may of the <br /> above, per inap~-.lion <br />O, Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each <br /> (sold only to electrical contrsctors) <br />H. Other <br /> (As required by Building O~ciaO <br /> Aurora Dwelling Electrical Fee <br /> I>,vel llng Permit Label <br /> <br />$50.00 -- 2 <br />$60.00 -- 2 <br />$100.00 2 <br />$130,00 __2 <br />$300.00 -- 2 <br />$40.00 2 <br /> <br /> $35.00 -- 2 <br /> <br /> $80.OO 2 <br /> <br /> $ 2.00 __ <br /> <br />$35.00 -- <br />$ 2.00 -- <br /> <br />$40.00 2 <br />$40.0O 2 <br /> <br />$35.OO -- <br />$50.00 -- <br /> <br />5. FEE8 <br /> A 1. Enter total of fees from Se~. #4 <br /> A2. Add 5% surcharg~ (.05 x Al) <br /> Subt~al <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br /> C, Investigation Fee (if required) <br /> D. Reinspection Fee ($25.OO) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br />__~q. fl. x $.068 = -- <br /># Of Labels. N/C <br /> <br /> <br />