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FOR CITY VALIDATION] <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Office: 588-514'/ 8:00 a.m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE 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 />Electrical Contractor ~/~ ~¥.~CT'~-[~. ~ Phone ~¥tg <br /> <br />Mailing Address ~55~ 5't~' {~/~-d,,,~t%q.z~7 <br /> <br />Contractor's License No. Z.~ -- ~ ~ ~ ~_~ <br />Contractor's Board Reg. No. ~, a',y ~ Job No. <br /> <br />Signature of Supervising Electrician <br />Supervisor's License No. ~ ~ ~7 -$' I Phone <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (please print) <br />Mailing Address Phone <br /> <br /> City/State/Zip <br /> Owner's Signature: · , ,~)~' <br /> <br /> Marion County does not require a plan revie~ <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-.;4 12/94 <br /> <br />3. PLAN REVIEW SECTION <br /> <br />PERMIT NO: <br /> <br />4. FEB SCHBDULB (Complete and enter total in Al below) <br /> Number ofhmpections per permit allowed --~ <br /> R~idential <br /> Per <br /> Unit <br /> 1 <br />Service Included: Items Cost (each) Sum ~ <br />1000 sq. ft. or less $85,00 4 <br />Each additionn1500 sq, ft. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 __1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 ~ 2 <br /> <br />B. Services or Feeders (Does not include branch circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less / $50.00 ~q'10 2 <br /> 201 amps to 400 amps $60.00 __ 2 <br /> 401 amps to 600 amps $100.00 __2 <br /> 601 amps to 1000 amps $130.00 __ 2 <br /> Over 1000 amps or volta $300.00 -__ 2 <br /> Reconnect only $40.00 __ 2 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alteration, or Relocation <br />200 amps or less $35.00 <br />201 amps to 400 amps $40.00 <br />401 amps to 600 amps $80.00 <br />Over 600 amps or 1000 volta <br />see "B" above <br />D. Branch Circuits <br />New, Alterations, or Extension Per Panel <br />a) The fee for branch circuits with <br />purchase of service of feeder fee <br />Each branch circuit $ 2.00 <br /> <br />b) The fee for branch circuits without <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.~ <br />$2.~ <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br />Each pump or irrigation circle $40.00 2 <br /> Each sign or outline lighting $40.00 ~ 2 <br />Signal circuit(s) or a li~nited energy <br />panel, alteration or extemion $40.00 2 <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, per Inspection $35.00 <br />Gl. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />H. Other <br />(As required by Building Oll~cial) <br />Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label N/C <br /> <br /> sq. Il. x$.06 = __ <br /># of Labels <br /> <br /> 1. Enter total of fees from See.//4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Subtotal <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNTDUE <br /> <br /> <br />