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FOR CITY VALIDATION <br />Received by: <br />Dater <br /> <br />MARION COUNTY BUILDING INSPI~CTION <br /> COMMUNITY DEVELOPMENT CEN'I~R <br /> 285 Church StNE· Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 Hr Ittepeetioa Li~e~ 588-7904 <br />O t~e: 5g1~$147 <br /> FAX t 558-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through ~,,J <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> P]SRMITS AR~ NON-TRANSI~RABL~ AND I/XPIRE IF WORK IS NOT <br /> STARTED WITI-IIN 180 DAYS OF ISSUANC~ OR IF <br /> WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />I Job <br /> <br />Signutum of Supervising Electrician <br /> <br />2B. FOR OWlqI~ INSTALLATIONS <br /> <br />Property Owner (ple~e£t'int) <br /> <br />Mailing AddreSs I Phone <br /> <br />3. PLAN RBVIEW SBCTION <br /> <br />IMarion 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 />M~ I.¢-,{4 12/P4 <br /> <br />PERMrF NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FBE SCHEDULE (Complete and ente~ total in Al below) <br /> Number of Inspections p~ ~it allowed <br /> P~ <br /> Unit <br />~vi~ in~d~: Items ~sC (each) Sum <br />~h additional 3~ aq. fl. <br /> <br />B. 8~vle~ os' Fe~k~ s (Does not include bnmch ¢iyeults, see section D) <br /> / <br /> 200 amps or less ~ $30,00 2 <br /> <br />C, Tompnsary Servic~/Fe~lets <br /> Installation, All.alien, or Relocation <br /> 200 ~nps or lev~ <br /> 201 amps to ~0 <br /> <br />D, ~ran~ <br /> <br /> a) ~e fee f~ <br /> <br />$35.00 ~ 2 <br />$40,00 -- 2 <br />SBO,00 .... g <br /> <br />__sq. 11. x$,06 =__ <br /> <br />E. Miscellaneous (~erviee Or Feeder Not Included) <br /> Each pump or irrigation ¢it~le $40.00 <br />Each siL~ o~ oatline lishting ~ $40,00 __ <br />Signal circuit(s) or a limited enea~y <br />panel, alt elation or extension $40.00 <br />1~. leach additional in~peotion <br />Over the allowable in any of the <br />above, per Inspaetion $35.00 -- <br />O, Minor l{Istallatlon Labels <br />Pack of 10 labeA$ @ $5,00 each $50,00 <br />(~Md only to electrical eoatc.~ctor0 <br />H, Oth~ <br />(As required by Building O~eial) <br />Aurora Dw~ll/n~ Electrical <br /> <br />$35.00 <br />$ 2.00 <br /> <br />Dwelling Peimlt i. abel # of Labels__ <br /> <br />2 <br /> <br />ELVES <br />A I. Entre total of fees from S~,/~- $.__ <br />A2, Add 5% sun, hats (,05 x At) <br /> Subtotal <br /> <br />B, Enter ¢,~% of line A 1 for Plan Review <br />($¢¢, 3), ifmqui~d $ , <br />C, Investigation Fee (if~quired) <br />D. Reimpection ~¢e ($25.~) <br /> <br /> ~T~ ~O~ DUE $ <br /> Receipt No,, <br /> <br />$ <br /> <br /> <br />