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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE * Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: S88-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />D~fiom <br /> <br />PERMITS ARE NON-TRANSFERABLE AND F~XPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> ' <br /> <br />2B. FOR OWNI~ INSTALLATIONS <br /> <br />Property Owner (p/e~g print) <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLANRBVInW 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 />PERMIT NO: .~'~) <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDUL~ (co~pleta and eats- ~ h A 1 ~w) <br /> <br />~ R~d~tial P~ Unit N~ of~e~ons p~ ~it ~ <br />~vi~ In~d~: Ite~ ~t (~h) S <br />l~8q, fl. ~le~ $~.~ 4 <br />~ ad~ 5~ sq. ~ <br /> ~ ~on ~f $15,~ <br />~i~d E~r~ ~0.~ 1 <br />~ch Ma~fac~ Home or Mo~lar <br /> ~ling ~ice or Feed~ ~.~ 2 <br /> <br />B. S~i~ ~ F~s (~ ~t inclu~ ~nch al=ui~ ~e sect~ D) <br /> <br /> s o.oo <br />$60.O0 2 <br />$100.O0 2 <br />$I~0.O0 -- 2 <br />$30O.O0 2 <br />$4O.OO 2 <br /> <br />$35.O0 2 <br />$40.O0 2 <br />$~.O0 2 <br /> <br />$ 2.O0 <br /> <br /> b) The fee for branch circuits wilhout <br /> <br /> First branch circuit $35.00 <br /> Each additional branch circuit $ 2.00 -- <br /> <br />E. Miseallaneous (Se~vlee or Feedw Ha Included) <br />Each pump or in'igntion cir=le $40.00 -- 2 <br />Each sign or outline lighting $40.00 -- 2 <br /> Signal circuit(s) ora limited energy <br /> pnnel, alteration or extenalcn $40.00 2 <br />F. Each additional Inspeotion <br />Over the allowable in any of the <br />above, per Inspection $35.00 -- <br />fi. Minor Installation Lnbels <br />Pack of 10 labels O $5.00 each $50,00 <br />(sold only to electrical co.factors) <br />H, Oth~ <br />(~ ~'equired by ~uddfi2g O[~cial) <br /> Aurora Dwelling Electricnl Fee __~q. f. x $. 068 = -- <br /> Dwelling Permit Label # of Labels. N/C <br /> <br />FEES <br />Al. Enter Iotal of foes from Sec. #4 $ <br />A2. Add 5% surch~ge (.05 x Al) $ ~,~ <br /> ~bt~al <br /> <br />B. ~tar 25% of llne A I for P~ Renew <br /> (S~. 3), if ~qui~ <br />C. Inv~fignfion ~= (ifreq~d) <br />D. Ral=p~tion F~e ($25.~) <br /> <br /> TOT~ ~O~ D~ $ <br /> Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />