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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 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job Address o~ 7~ ~_ (~)/t'~ A'~a~O <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 ] 80 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br /> <br />Address <br /> <br />Fa~ <br /> <br />Phone// <br /> <br />lob No. <br /> <br />Property Owr~r <br /> <br />Contractors License No. <br /> <br />Contractor's Boitrd Peg No. <br /> <br />Signature of Supervisin~ Electrician <br /> <br />Supervisor's License No. ]Phone$ ] <br /> <br />liB. FOR OWNNR INSTALLATIONS <br /> <br /> 3. PLANRBVIBW 8BCTION <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 phns and <br /> specifications with this application. <br /> <br />MC 15-341/96 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />q <br /> <br />4. FBB SCHEDULE (Complete and enter total in Al below) <br /> Number of Inspections per pelmit allowed -~ <br /> Residential <br /> Unit <br /> <br />1000 sq. fl. or less $85.00 4 <br />Each additional 500 sq. ft. <br /> or portion thereof $15.0O <br />Limited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 -- 2 <br /> <br />B. Services or Feede~a (Does not include branch circuits, see section D) <br /> Installation, Alterati~ or Relocation <br /> 200 amps or less ~" $50.0O __2 <br /> 201 amps to 400 amps $60.00 -- 2 <br /> 401 amps to 600 amps $10O.00 -- 2 <br /> 601 amps to 1000 ~nps $130.00 -- 2 <br /> Over 100O amps or volls $300.00 __ 2 <br /> Reconnect only $40.00 -- 2 <br /> <br /> 200 amp~ or less $35.00 -- 2 <br /> EaCh branch circuit ~ $ 2,00 __ <br /> <br />E. Miscellaneous (Service or Foed~ No~ Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extension <br />F. Each additional Inspeetinn <br /> Over the allowable in any of the <br /> above, per Inspection <br />O. Miner Installation Labels <br /> Pack of l0 labels @ $5.00 each <br /> (sold only to electrical contractors) <br />H. Other <br /> (As reqoir~d by B~dding Official) <br /> Auwra Dwelling Electrical Fee <br /> Dwelling Fennit Label <br /> <br />$35.00 -- <br />$ 2.0O -- <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 -- <br />$50.0O <br /> <br /> sq.fl. x $.068 = <br />#ofLabels N/C <br /> <br />5. FEES <br /> A 1, Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reimpectinn Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />