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FOR C~TY VALIDATION <br />R~ceived by:, . <br />Date: <br /> <br />MARION COUNTY BUILDING I~SPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />2A Hr Inspection Line: 588=7904 <br />Office: 588-5147 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INS'rALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Slec~iealCon~etor Judson' s, Inc. [ Phone 363-4141 <br />Main~g^ddress PO BOX 12669 Salem, OR 97309 <br /> <br />l~opsny Owner L-O/"C~A. ~ <br /> <br />Contractor's Licease No. 2 4-1 8C <br /> <br />Co~'actor', Bo,rd P~g. No. 34~0~ [ Sob NoZ~L/O Zl~ <br />Su~rvisor's Licen.e No. 1~69_S I Phone 565_4141 <br /> <br />3. PL <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 />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> Nmnber of lmlnctions per pea"mit allowed <br /> u -.... <br />A. Rmldential pe~ Unit <br /> Sum ~ <br /> <br />Do <br /> <br />Installation, Alte~atiea or Relocation <br />200 amps or less / $50.00SO 2 <br />201 amps to 400 amps $60.00 -- 2 <br />401 snaps to 600 amps $100.00 2 <br />601 amlm to 1000 amps $130.00 2 <br />Over 1000 amps or volta $300.00 -- 2 <br />Reconnect only ~40,00 -- 2 <br /> <br />Installation, Alt~tation, or Reioeation <br />200 amps or less ~ $35.00 -- 2 <br />2~1 amps to 400 amps e~ $40.00 -- 2 <br />401 amps to 600 amps $80.00 -- 2 <br /> <br />Branch Circuits <br /> <br />a) The fee for branch elreuita ~ <br /> nurchase of service of feeder fee <br /> <br /> $35.00 <br /> <br /> Each additional branch circuit $ 2,00 -- <br /> <br />E. Miscellaneous (Service cr Peeder N~ Included) <br />Each pump or irrigation circle M0,00 -- <br />Each si~n or outline lighting M0.00 -- <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, per Inspection $35.00 -- <br />G. Min~ Installation Labels <br />Pack of hO labels @ $5.00 each $50.00 <br />(sold oaly to electrical co~tractors) <br />H. Other <br /> (As required by Building OiTwiaO <br /> Aurora Dwelling Electrical Fee sq. E..T $06 = -- <br /> Dwelling Permit Label # of Labels N/C <br /> <br />5. FEES <br /> A 1. Enter total of fees fwm See. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (See. 3), if reqthred <br /> C. Investigation Fee (if required) <br /> D. Reimpecfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br />$ 6,.,'7, Zo <br /> <br />s ?-o <br /> <br /> <br />