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FOR CITY VALIDATION <br />Received by: <br />Date: <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. Inspection Line $73-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cross Si~Dirmtiom: <br /> <br />PERMITS ARE NON-TRANSFERABLE ~ EXI}IR~ IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />:gA. CONTRACTOR INSTALLATION ONLY <br /> <br />Sigmiure of Supervising Electrician ~ <br />Supervisor's License bio. t/{. 73 .~ ] Phone# <br /> <br />2B. FOR OWHBR INSTALLATIONS <br /> <br />Prognrty Owner (ph~s~ prim) <br /> <br />Mailing Addrean [ Phone <br /> <br />Cit~/statdZip <br /> <br />Owner's Signature: <br /> <br />3. PLANREVIBW $11CTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. 1:{[~ SCH~DIIJL~ (Complete and enlet total in Al below) <br /> <br /> A. R~id~tlal i~ UaitNumber oflnsp~ctinns I~r permit allow-d ---~ <br /> Servie$ lneluded: Itema Co~t (each) S <br /> 1000 ~q. t'c or te~ $85.00 4 <br /> Each additiorml 500 sq, ft. <br /> or poaion thereof $15.00 <br /> Limited Energy $20.00 1 <br /> Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 <br /> <br />n. 8erviee~ or Fe~dm'~ (Doea not include branch circuil$, aec ~eetion <br /> <br /> 200 amps or le~a $50.00 -- 2 <br /> ~01 mpnto400~mpa $60.00 __2 <br /> 401 ~rap~ to 600 ~mps $100.00 2 <br /> 601 ampa to 1000 ampa $130.00 2 <br /> Over 1000 ampa or volta ~30.00 <br /> Recom~ect onlx $40.00 <br /> <br />~. Temporary 8ervinea/Feeder~ <br /> <br /> 200 amps or l*n $$5.00 -- 2 <br /> 201 ampa to 400 ampa ,~0.00 __9. <br /> 401 ampa to 600 ampa $80.00 __2 <br /> Over 600 amps or 10~0 volta <br /> <br />D. Branch Circuits <br />a) The fee for branch ¢ireuita ~ <br />Each branch ¢imuit $ :L00 -- <br /> <br />First branch circuit ~ <br /> ,/ <br /> <br />Each sign or outline lighting <br />Signal circuit(s) or n limiw~l energy <br /> <br />Pack of 10 labds ~ $5,00 each <br /> <br />(As required by Boilding O~ciaO <br /> <br />$35.00 <br />$ 2.00 __ <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> sq. fl. x $.068=__ <br />#0fLabe~ NIC <br /> <br />5. FEES <br /> Al. E~ter totaloffees fwm S~. #4 <br /> A2. Add 5% surchnrg~ (.05 x Al) <br /> Subtotal <br /> <br /> B. En~r 25% of line Al for Plan g~i~w <br /> (Sec. 3), if required <br /> C. l~a~tigation ~ (if ~qui~) <br /> D. Re~fion Fe~ (~5.~) <br /> <br /> ~T~ ~O~ D~ <br /> R~ipt No. <br /> <br />$ <br />$ <br /> <br />$ <br />$ <br /> <br />$ <br /> <br />MC 15-341/96 <br /> <br /> <br />