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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 />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cross StreeffDirections: /~'~'~'~t~.~..J <br />Job Descripdon: ~ g~.~,/ ~{~, <br /> <br />Pf~.M]TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHI~ 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> ~tu~lltum Electrical Const., /nc. <br />Electrical ConUactor1474 . 3~th Ave. N. VV. <br />~.~elem. Oregon 97304 <br />Address ~3~,..~,.4 ~,,~~, <br /> <br />Fa~ <br /> <br />Phoneg <br /> <br />Contractor's Board Reg No. ~Tq~v",~ t~ff [ IobNo. <br />SignatureofSupervisingElectrician ~,n¢~ ~ <br />Supervisor's Liceme NO, ~s~ ~,)~ C.~ / Phon~ <br /> <br />2B. FOR OW2q-~R INSTALLATIONS <br /> <br />P~op~t'ty Owner ~o/e~sopri~t) <br /> <br />City/Sm~ip <br /> <br />3. PLAN RBVIBW SIlCTION <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 />PERMIT NO: <br />Date: <br /> <br />ct 7-oc/ 70 <br /> <br />Issued by: <br /> <br />4. FIlE SCHEDULII (Complete and ente~ total in Al below) <br /> Number of Inspections p~r permit allowed <br />A. Residential Per Unit <br /> <br /> Installation, Altecation ct Reloeati~ <br /> 200 amps or less $50.00 2 <br /> 201 amps to 400 amps $60.00 -- 2 <br /> 401 amps to 600 amps $100.00 2 <br /> 601 amps to 1000 maps $130.00 -- 2 <br /> Over 1000 amps or veils $300.00 2 <br /> Reconnect only $40.00 <br /> <br />C. Temperary 8ervieesiFeeders <br />Installation, Alteration, or Relocation <br />200 amps or less $35.00 2 <br />201 amps to 400 amps $40.00 --2 <br />401 amps to 600 amps $80.00 --2 <br />Over 600 amps or 1000 wits <br />~ 'B" above <br />D. Branch Circuits <br />Nmv, Altecations, er Extension Pet Panel <br />a) The fee for branch circuits ~ <br />purchase o f service of feeder <br />Each branch circuit <br /> <br /> $ 2.00 <br /> <br /> b) The fee for branch ¢irguha without <br /> <br /> Each additional branch circuit $ 2.00 -- <br /> <br />E. Miaeellaneons (Service or Foeder Nt~ lnoluded) <br />Each pmnp or irrigation ckcle $40.00 2 <br />Each sign or outline lighting $40.00 2 <br />Signal circuit(s) or a lhnited energy <br />panel, alteration or extension $40.00 2 <br />P. Each additional Inspection <br />Over the allowable in any of <br />above, per Inspection $35.00 -- <br />O. Mino~ InMallation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrical cocarzctors) <br />H. Other <br />(As required by Building O~cial) <br />Aurora Dwelling Eleclrical Fee <br />Dwelling Permit Label N/C <br /> <br /> sq. fl. x $.068 = <br /># of Labels <br /> <br />5. FEES <br />A 1. Enter lotal of fees from Sec.//4 $.__ <br />A2. Add 5% surcharge 605 x Al) $.__ <br /> Subt~al $ <br /> <br /> B. Enter25%oflineAlforPlanRevie..W.n/ .~ $~ <br /> (Sec. 3), if required t~ ,Jif <br /> C. Investigation Fee (if required) ~, [ <br /> D. Reimpeetion Fee ($25.00) ~" S- <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. <br /> <br /> <br />