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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSP~TION ~.~Y~)~f- ..~ <br /> 285 Church St NE' Room 132 pgrf~"~O :~'~/,~(.tfi~ ~'b?~._ <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 />Date: ,. .!: <br /> <br />tssuen- i , , <br /> <br />IELECTRICAL PERMff APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> ~S A~ NON-~NS~B~ AND ~ ~ WO~ IS N~ <br /> ST~ ~ 1~ DAYS OF [SSUAN~ OR ~ <br /> WO~ IS SUSP~D~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR O~ INSTALLATION'S <br />Pmpe~y Owner ~1~ prim) <br /> <br />M~ili~ Addz~ I Phone <br /> <br />C'ity/S mt~Zip <br /> <br />Owner's Si~m~: <br /> <br />3. PLANRBVIBW 5BCTION <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 1/96 <br /> <br />4. i~B $CHEDULB (Complete and enter total in A1 below) <br /> <br />A. Rmidential Per Unit Numberofinspectlom per permit allowed *~ <br />~rvle~ Included: [tem~ Co~t (each) S <br />1000 sq. II. or I*ss $85.00 4 <br />Each additlonsl 500 sq. ft. <br /> <br /> Installation, Alteration ~r Relooatinn <br /> 200 amps or less $50.00 2 <br /> 201 amps to 400 amps $60.00 2 <br /> 401 amps to ~ amps $I00,00 2 <br /> 601 amps to 1000 ~anps $130.00 __ 2 <br /> Over 1000 amps or volts $300.00 2 <br /> Reconnect only $40.00 -- 2 <br /> <br />C. Tmnp~ary 8ervi~s~ders <br />Installation, Alteratina, or Relocation <br />200 amps or less $35.00 2 <br /> <br /> 401 amps to 600 amps $80.00 2 <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Cir~its <br />N~v, Alterations, or Exteaslon Per Panel <br />a) The fee for branch circuits ~ <br />ourchase of service of feeder fee <br />Each branch cir*uit $ 2.00 -- <br /> <br />b) The fee for branch circuits wilhout <br /> purchase of service or feeder fee <br />First brach circuit <br />Each additional branch circuit <br /> <br />$35.00 <br />$ 2.o0 <br /> <br />N/C <br /> <br />5. FLIES Al. Entar total of fees from Sec. #4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br />B. Enter 25% of lineAl for PlanR~view <br /> (Sec. 3), if requimd <br />C. Inv~tigation Fee (ifrequi~d) <br />D. Reinspection Fee ($25.00) <br /> TOTAL AMOUNT DUB $.~L_.. <br /> Receipi No. <br /> <br />E. Miscellaneous (Se~vine or Feeder N~ lneluded) <br />Each pump or irrigation circle $40.00 <br />Each sign or outline lighting $40.00 -- <br />Signal circuit(s) or a limited energy <br />panel, alteration or ~xtemion $40.00 <br />Each additin~al Inspeotion <br />Over the allowable in any of lbo <br />above, per Impectinn $35.00 <br />G. Minor Installation Labels <br />Pack of 10 labels ~ $5.00 each $~0.00 <br />(sold only to ele~tricz l oootrz¢tors) <br />H. Other <br />(As required by BO#diog O~iM) <br /> Aurora Dwelling Electrical Fcc --~q. fi. x $. 068 = -- <br /> Dwelling Permit Label # of Labels <br /> <br /> <br />