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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 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~ections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Signature of Supervising Electrician <br /> <br />2B. FOR OWNER iNSTALlATIONS <br /> <br />Properly Ownor ~le~s~ print) <br /> <br /> CiyStnte/Zip <br /> <br /> Owner's Signatt~-e: <br /> <br /> 3. PLAN REVIEW SECTION <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 15-34 1/96 <br /> <br />4. FEE SCHEDULE (Complete and enter mml in A1 below) <br /> Nmnbe~ of Inspections per permit allowed ~ <br />A. <br /> Relideminl <br /> Unit <br />Service ineinded: Items Coat (each) Sum <br />1000 sq. fl. or less $85,00 4 <br />Each additional 500 sq. ft. <br /> or pe~on ~hereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Fe=der $40.00 2 <br /> <br />B. Servioes or Feed~s (Does not include branch ¢ircult~, nee neetinn D) <br /> <br />n) Tae fee for branch cimuita with <br /> <br />b) 'l~e fee for branch cir~ints without <br /> p~haae of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br /> $50:00 ~ <br /> $60.00 __ 2 <br />$100.00 2 <br />$130.00 2 <br />$300,00 2 <br /> $40.00 __2 <br /> <br />$35.00 2 <br /> <br />$80.00 -- 2 <br /> <br />$ 2.00 -- <br /> <br />$35.00 <br />$ 2.00 <br /> <br />E. Mi~dlane~as (Sm'vine m' Feede~ N~ Include) <br /> ~ pump or ~g~n ~i~le ~.~ ~ 2 <br /> <br /> Si~ c~uit(s) ~ n I~ ~ <br /> ~el, ait~tinn or exte~ion $~.~ <br /> <br /> ~er the allowable in any ~ ~e <br /> a~ve, ~r ~pection $~.~ ~ <br /> <br />H. 0~ <br /> <br /> A~ ~elling Elec~cal F~ sq. ~. x $. 068 = ~ <br /> <br />5. FEES <br /> A 1. Eater to~al of fees fmm S.. fi4 :~ <br /> A2. Add 5% surchar~ (.05 x A 1) <br /> Subtotal <br /> <br /> B. ~ter 25% of line Al for P~n Renew <br /> (Soc. 3), if ~q~md $~ <br /> C. ~vmtiga~n Fee (if~) $__ <br /> D. Re~p~tion ~ ($25.~) $~ <br /> <br /> T~ ~O~ D~ S ~ <br /> <br /> <br />