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f ] MARION COUNTY <br />--IFOR CITY VALIDATION| BUILDING INSPECTION DIVISION PERMIT NO: <br /> <br /> I ! 3150 Lancaster Dr. NE - Suite C <br /> Received By: _ --/ Salem, Oregon 97305-1398 Date: <br /> IDate: -- --I ~4 HR Inspection Line 373-4427 <br /> ~ Office: phone 588-5147 8:00am - 4:30pm Issued by: <br /> <br /> _ - ~ f ' FAX 588-7948 <br /> <br /> £~AL PER_MITAPPLICATION I ~ULE (Complete and enter total in Al below) <br /> Please complete all Sections, 1 through 5I Numberoflnspectionsperpermitallowed <br /> ~ A Residential Per Unit <br /> Items <br /> (each) <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I PROPERTY OWNER <br /> <br /> ~o~s STrEEt/ <br /> <br /> PROIE(Tr DESCRIPTION <br /> <br /> WORK IS SUSPE~ED ~R 180 DAYS. <br /> <br />2A. CO~CTOR INSTALLATION ONLY <br /> <br />2B. FOR eWeR INSTALLATIONS <br /> <br /> Mailing Address <br /> <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 <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 7/97 <br /> <br /> Installation, Alt~rniton or Rel~afion / ~ <br /> 200 amps or less $50.00 2 <br /> 201 amps to 400 amps $60.00 ____2 <br /> 401 amps to 600 amps $100.00 ---- 2 <br /> 601 ~raps to 1000 amps $130.00 2 <br /> Over [000 amps nr volts $300.~0 2 <br /> Reconnect only $40.00 2 <br /> C. Temporary ServicealFeeders <br /> Installation, Alterations, or Relocation <br /> 200 amI~ or less $35.00 ---- 2 <br /> 201 amps to 400 amps $40.00 2 <br /> 401 amps to 600 amps $80.00 __2 <br /> Over 6~0 amps or 1000 volts see "B' above <br /> D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> a) The fee for branch circuits with <br /> <br /> / <br /> Each branch circuit ~ $2.00 -- <br /> <br /> b) The fee for branch circuits without <br /> <br /> First branch circuit $35.00 <br /> Each additional branch circuit $2.00 <br /> E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irrigation circle $40.00 2 <br /> Each sign or outline lighting $40.00 2 <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension $40.00 ---- 2 <br /> <br />]g Each additioanl Inspection <br /> Over the allowable in any of the <br /> above, Fer Inspection $35.00 <br /> <br />G. Minor Instatiatlon Labels <br />Pack of 10 labels @$5.00 each $50.00 <br />(sold only to elecl~ical contractors) <br />H. Other <br />(As required by Building Officials) <br />Aurora Dwe0thg Electrical Fee sq. ft. x $.068 = <br />Dwelling Permit Labnill of Labels ~ <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. 44 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if requirad <br />C. Investigation Fee (if requtiad) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br /> $ <br /> $ <br /> $ <br />TOTAL AMOUNT DUE $ 6 ~ * ~' ~ <br /> <br /> <br />