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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 <br /> Salem, OR 97301 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF I~STALLATION <br /> <br />ci~ Atvq ~' V l L ~ ~.. <br /> <br />PERMff NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Pho~ 58S-5147 $:00am - 4:3~m <br />F~: 58~7948 <br /> <br /> P~ <br /> Unit <br /> ~vi~ inc~d~: lte~ C~t (e~h) S~ <br /> <br /> ~ch ed~o~l 5~ sq. ft. <br /> or ~aioa ~f $15.~ <br /> <br /> ~eh M~ufaetu~ H~ or Mo~ <br /> <br /> B. 5~i~ ~ F~s (~s not ~lud¢ ~ch ei~ui~ see section D) <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. CON'ft~tCTOR INSrALLATION ONLY <br /> <br />Phone~ <br /> <br />Address 13307 <br /> <br />Signature of Supervising Electrician <br /> <br />2B. FOR OWNRR IHSTALLATION5 <br /> <br />PrOl~ty Owner (p/e~seprim) <br /> <br />,Mailing Address ) Phone <br /> <br />Cily/S rate, Zip <br /> <br />Owner's Signature: <br /> <br />3. PLANRBVIBW SECTION <br /> <br /> Installation, AIt~atkm or Relocation <br /> 2~0 amps or less <br /> 20 l amps Io 400 amps <br /> 401 amps to 600 amps <br /> 601 amps to I000 amps <br /> Over 1000 amps or volts <br /> <br />C. Temporary 8ervic~,~'eedar~ <br /> Installation, Aheeati~, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> <br /> Over 600 amps or 1000 vol~s <br /> <br /> a) The fee for branch circuits xv~th <br /> lml~hase ofaerviee of feeder fee <br /> Each branch circuit <br /> <br /> b) The fee for branch circuits without <br /> purchase of service or feefl~ fee <br /> First branch ekeuit <br /> Each additional branch circim <br /> <br />E. Miseellaneoua (~rvi~e or Feedee blot lnduded) <br /> Each pump or irrigation <br /> Each si~ or outline lighting <br /> Signal circuit(s) or a limited ~ncr~y <br /> <br />P. Each mdditlonsl <br /> Over the allowable in any of the <br /> above, per Inspection <br />O. Miner Installation Labels <br /> Pack of lO labch ~ $5,00 each <br /> <br />H. Other <br /> (As reqv4ved by ~ild~g <br /> Aurora Dwelling Electrical F~ <br /> <br /> $60.O0 -- 2 <br />$100.00 2 <br />$130.00 2 <br />$300.00 2 <br /> <br />5. FEES Al. Enter ~otel of fee~ from See. #4 <br /> A2. Add5% surcharge (.05 xAl) <br /> <br />B. Eater 25% of Frae Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DU~ <br /> Receipt No. <br /> <br />$35.00 ~ 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />s .oo 0 <br /> <br />$35.00 ~0 <br />$ 2,00 <br /> <br />$40.00 2 <br />$40.00 __2 <br /> <br />$40.00 2 <br /> <br />$35.00 -- <br />$50.00 <br /> <br />sq. fi. x $.068: -- <br /> NIC <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 />MC 15-341/96 <br /> <br /> <br />