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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 />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF I~STALLATION <br /> <br />2A. COIqTRACTOR INSTALLATION ONLY <br /> <br />liB. FOR OWNER INSTALLATION5 <br />Properly Owner (pt~s~prim) <br /> <br />Mailing Ad~s I fen°ne <br />City/State/Zip <br />Owner's Signnt me: <br /> <br />3. PLAN REVIEW SBCTION <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 /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEB -q4~HEDULE (Complete and em~ tutalin Al below) <br /> Number of lnspeetionll per permit allowed <br />A. <br /> R~ideminl <br /> P~r <br /> Unit <br /> S~-vie~ Included: Items Cost(each) Sum <br /> 1000 sq. ft. or less $85,00 <br /> Each additional 500 sq, ft, <br /> or portion thereof $15.00 <br />Limited Energy $20,00 . <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 <br /> <br />B. 8e~vieee or Feed~a (Doen not include branch eircuite, see se~tlon D) <br /> Installation, Alt~atien o~ Reloe, xtioe <br /> 200 amps or lens $50.00 <br /> 201 amps to 400 amps $60.00 <br /> 401 amps to 600 amps $100.00 <br /> ~01 amps to 1000 amps $130.00 <br /> Over lO00 amps or volts $300.00 , <br /> Reconnect only $40.00 <br /> <br /> Installation. Alt~'ation, or Relocation <br /> 200 amps or le~s $35.00 -- <br /> <br /> 401 amps to 600 amps $80,00 <br /> Owr 600 anpe or 1000 volts <br /> <br />D. Branch Ciee~ts <br /> New, A/terafion~, or Extension Poe Panel <br /> a) The fee for brmch circuits <br /> <br /> Each branch circuit $ 2.00 <br /> <br /> b) The fe~ for branch circuits without <br /> _ . <br /> Firat branch c{reuit / $35.00 <br /> Each additional branch ¢imuit ~ $ 9.00 -- <br /> <br />E, Mlao~itaneous (getvie~or Fzed~r Not lnoind~d) <br />Each pump or inigation circl~ $40.00 2 <br />Each sign or outline lighting $40.00 2 <br />Signal circuit(s) or a limited energy <br />panel, alleration or extensio~ $40.00 2 <br />F. Each additional Insp~ion <br />Over the allowable in nn~ of ~e <br />nbove, per Irtspection $35.00 <br />O. Minor Installation Labels <br />Pack of 10 labels ~ $5.00 e~¢h $50.00 <br />(sold only to electrical comr#ctors) <br />H. Othee <br />(As requimd by Buildi~ O~¢isl) <br /> Aurora DwetEng Electrical Fee --sq. ~. x $.068 = -- <br /> Dwelling P~rmit Label # of Labels. Fie <br /> <br />A 1. Enter total of fees from Sec. #4 <br />A2. Add 5% surcharga 605 x Al) <br /> <br />B, Enter 25% of line A 1 for Plan Review <br />(Sec. 3), if required $.__ <br />C. Investigation Fee (if required) <br />D. Reinspection F~e ($25.00) $.__ <br /> TOTAL AMOUNT DUE $.~ <br />Rec(~pt No. <br /> <br /> <br />