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FOR CITY VALIDATION <br />~Received by: <br />Da~¢: ..................... <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 Inspvction Linc: 58~-7904 <br />Office: 588-5147 8:00 san. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />Deaefipti(m <br /> <br /> PERMITS AP,~ NON-TRANSFERABLE AND BXPIRB IF WORK IS NOT <br /> STA RTF~D WITIqlN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR IS0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLy <br /> <br /> V---~,.,.,-.~-~ ~ / - "--~,~a~ , <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br /> l~pc~y Owner (please print) <br /> <br /> City/State/Zip <br /> <br /> 3. PL~REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review semite ify0u complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 1.~-34 1~ <br /> <br />4. FEE SCHEDU/~ (Complete and catcr total in A 1 below) <br />A. R~idential P~r Unit Ntanb~r o£ Inapections per permit allowcdl~ <br />1000 ~q, fl. or I~s~ $S5~00 4 <br /> <br /> Dwelling~r Feeder [ $40,00 __ 2 <br /> <br /> Installation, Alteration or Rolocation <br /> 200 amps Or less $$0.00 <br /> 201 amps to 400 affq~ $60.00 <br /> 4/)1 amp~ to 600 amps $100.00 <br /> 601 maps to 1000 amps $130.00 <br /> Owr 1000 nmpa or volts $300.00 <br /> R~¢onn¢ct only $40,00 <br /> <br />C- Tempcn'aty ServlcodP(~lOl'~ <br />Installation, Alteration, or Rolocation <br />~00 amps or Icss $35.00 <br />201 amps to 400 alllp~s $40,00 <br />401 alllps to 600 amps SP~0.00 <br />Over 600 amps or 1000 volta <br /> <br /> N~.v, Alt~ations, or £Xt~nsion Pot Panol <br /> a) 'Uae fee foe branch ei~u{t~ ~ <br /> p0c~has.~e of l~eder fee <br /> Each branch circuit $ 2.{Xl <br /> <br />E. Mi~ellaneous (Service cr Feeder Not Included) <br />Each pump or irrigation clr¢le $40.00 <br />Each $igll or outlina lighting $40,00 <br />Signal circuit0) or a limited energy <br /> <br /> Over the allowable in any of <br /> above, per Inspection $35,00 <br /> <br /> (A~ required by Buildit~ OlFtciM) <br /> <br />5. PRES Al, Billet tolal of fees fn)m See.//4 <br /> A2. Add 5% surcharge (.0S x Al) <br /> <br />Subtotal <br /> <br />B. Ealter 25% of line A I for Plan Review <br />(Sec, 3), if requited $. __ <br />C. Investigation Fee (ifrzq0ircd) $.__ <br />D. Rcimpcction Fe~ ($25.00) $ ........ <br /> <br /> ~T~ ~OU~ DUE $_~ <br />Receipt No. <br /> <br /> <br />