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ReceiveA by: . [ <br />[ Dat~: ~ I <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> Date: <br />24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 $:00am - 4:30pm <br />FAX: 588-7948 I$$UL~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete ail Eections, I through 5 <br /> <br />l. LOC ATION OF I~STALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Signature of Supervising Electrician <br />I Supervisor's Licertse No. <br /> <br />21t. FOR. OWN'HR INSTALLATIONS <br /> <br />3. PLAN' REVIBW SI:iCTION <br /> <br />IMarion 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 15-34 1/96 <br /> <br /> 4. FlqH SCHF:ff)ULB (Complele and ent~ total in Al below) <br /> Nmnber or'Inspections per p~rmit allowed <br /> A. Re~idomial p*r Unit <br /> <br />B~er v i~.or Feeder ~'~t intrude h~ach circuits, see sect km D) <br /> <br /> ' 201 amps to 400 amps $60.00 <br /> <br /> b) Thc £¢e for branch circuits without <br /> <br /> First branch clmuit $35.00 <br /> Each additional branch circuit $ 2.00 <br /> <br />~. Miseellaneoul (~rvie.~ ~ Feeder Not Included) <br />Each pump or irrigation circle $~0.00 2 <br />Each sign or outline lighting $40.00 2 <br />Signal circuit(s) or a limited energy <br />panel, aberalion or extension ~40.00 2 <br />F. Each additional Itmpaclioa <br />Over Ihe allowable in any of <br />above, per Inspection $35.00 -- <br /> <br /> Pack of 10 labels @ $5.00 each $50.00 <br /> <br /> (Aa required by Building O~cial) <br /> Aurora Dwelling Electrical Fee sq. fi. x $.068 =__ <br /> Dwelling Permit Label ff of Labels NIC <br /> <br />5. FEES <br />A I. Enter total or' fees lmm Sec. #4 5.__ <br />A2. Add5% surcharge(.05 xA[) <br /> Subtotal $.__ <br /> <br /> B. Enter 25% of line A ! for Plan Review <br /> (Sec. 3), ir required $.__ <br /> C. Investigation Fee (if required) $.__ <br /> D. Reinspection Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUI~ $ <br /> Receipt No. <br /> <br /> <br />