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D~ate:FOR CITY VALIDATION <br /> Received by: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~Sections, I through 5 <br /> <br />l. LOCATION OF INSTALLATION <br /> <br />24 Hr Inspection Line: 588-7904 <br /> <br />Ofl~co: 585~- 4:30 p.m. <br /> <br /> ~iABiON <br /> <br />Date: <br /> <br />Issued by: <br /> <br />~.9~E ~ICI-I]tDUL]~ (Complete and enter tolal in Al below) <br />]~T~dent iai Pe~ Unit Nmnber of Inspections per permit allowed <br /> <br />. ~.~8~I nclud ed: Items Cost (each) Sum <br />}~ ~q~.~t. or less $85,00 <br /> <br />PERMITS ARE NON-TRAHSFERABLE AND EX~IRE IF WORK IS NOT <br />STARTHD WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Reg. Ho. <br /> <br />liB. FOR OWNI~R INSTALLATIONS <br /> <br />Property Owner (pier.prim) <br />Maihng Address J Phone <br />City/S~atdZip <br />Owner's Signature: <br /> <br />3. PLAN'RI~VIEW SBCTION <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 witll this al~plicaflon; ~ - <br /> <br />l <br /> <br />MC 15-.~4 12/94 <br /> <br />Each additional 5¢0 sq. fl, <br /> or portion thereof $15.00 <br />Lirdited Energy $20.00 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Fe~der $40.00 -- <br /> <br />B. Services of Feeders (Does not include branch circuit~, see section D) <br /> <br /> Installation, Alteratkm or Reio~ttion <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 601 amps to 10O0 amps <br /> Over 1000 amps or volts <br /> Re¢onn~t only <br /> <br />C. T~nporary 8erviooMFeed~rs <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 maps to 600 amd <br /> Over 600 maps or 1000 volts <br /> <br /> D. Branch Cireuitn <br /> New, Alterations, or Extension Per Panel <br /> a) The fe~ for branch circuilz ~ <br /> mtrchase of service of feeder fee <br /> EaCh branch circuit '~ <br /> <br /> b) Tho fee for branch eimdits without <br /> purchase of service or fe~lcr fcc <br /> First branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service of Feeder Not Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or ex~v. sion <br />F. Each additional Inspection <br /> Over thc allowable in any of the <br /> above, per Inspection <br />G. Minor Instsllation Labels <br /> Pack of 10 labels @ $5.00 each <br /> (sold only to electrical contra ctor~) <br />H. Other <br /> (As required by Budding Ol~cia0 <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />/ moo <br /> $60.00 2 <br /> $100.00 2 <br /> $130.00 -- 2 <br /> $300.0O 2 <br /> .$4O.OO <br /> <br />$35.00 2 <br />$40.0O 2 <br />$80.0O 2 <br /> <br />$ 2.00 <br /> <br />$35,00 -- <br />$2.~ <br /> <br />.$40.00 -- 2 <br />$40.00 -- 2 <br /> <br />$40.1)0 -- 2 <br /> <br />$35.00 -- <br />$50,0O -- <br /> <br /># of Labels <br /> <br />5. FEES Al, Enter total of foes from Sec. #4 <br /> A2. Add 5% surcharg~ (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. - <br /> <br /> <br />