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FOR ,CITY VALIDATION <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING <br /> INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE - Room 132 pi= <br /> Salem, OR 97301 <br /> <br /> Date: <br /> <br />IELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br /> 24 Hr Inspection Line: 588-7904 <br />Ofllce: 588-5147 8:00 a.m. - 4:30 p.m. <br /> <br />Directions <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE tF 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 />Eleclrical Conlra c to~_~~---~['. <br /> <br />Property Owner <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pmperly Owner (please print) <br /> <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLANREVIEW 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 /> tssu A/tln <br /> " °uuAll , <br /> '~ z lUN <br /> <br /> N~r of~m ~ ~it al~w~ <br /> Rmidenfial <br /> P~ <br /> Unit <br />~ Include: lt~ ~t (each) <br />I~ sq. fl. ~ le~ $85.~ 4 <br />~ch addit~nal ~ ~. fL <br /> or ~n ~e~f $ ! <br />Limited Energy $20.~ . 1 <br />~ch Manufactu~ H~e or M~lnr <br /> Dwell~g ~ice or F~ ~.~ ~ 2 <br /> <br />B. ,%rvleea or Feeders (Doea not include branch circuits, see section D) <br /> Installation, Alteration or Rdoeation <br /> 200 mnps or less J $50.00~ <br /> 201 amps to 400 amps $60.00 . 2 <br /> 401 mnps to 600 amps $100.00 ~ 2 <br /> 601 amps to 1000 amps $130.00 ~2 <br /> Over 1000 amps or vails $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 amiTM $40.00 <br />401 atnps to 600 amps $80.00 <br />Over 600 maps or 1000 volts <br />see "B" above <br />D. Branch Circuita <br />N~w, Alterations, er Extension Per Panol <br />n) The fee for branch circuits with <br />purchase of service of feeder fee <br />Each brnnch 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 />$35.00 <br />$ 2.00 <br /> <br />E. Misedlaneous (servie~or Feeder Not Included) <br />Each pump or inigatinn ei~le $40.00 <br />Each sign or outline lighting $40.00 <br />Signal circuit(s) or a limited energy <br />panel, nllerati~m or exlemion $40.00 <br />P. Each additional lnspeclion <br />Over the allowable in any of the <br />above, per lmpection $35.00 <br />O. Miner Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical contractors) <br />H. Other <br /> (A~ required by Building O~ciM) <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />~q. ~ x $.06 <br /># of Labels. <br /> <br />N/C <br /> <br />FEES <br />A !. Enter tolal of fees from See. <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />~ubtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), il' required <br />C. Investigation Fee (if required) <br />D. Reimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. __ <br /> <br />%it 1,f-34 12~4 <br /> <br /> <br />