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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: 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 58B-7948 <br /> <br />PERMIT NO: <br /> <br />Dale: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />Di~ctlom <br /> <br />PERIvffrs ARE NON-TRANSI~RABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDE~ FOR I80 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />~e~,~calco.~c~ Judson's~ Inc. I Imc,,e 363-4141 <br /> <br />I~ilingAddr~ PO Box 12669 Salem~ OR 97309 <br /> <br />2.B, FOR OWN]ER ll~ISTALLATIONS <br />Property Owr~r (p/easeprint) <br /> <br />Mailing Addr~a [ Phone <br />CitylStata~ip <br />Owner's Signature: <br /> <br />3. PLAN REVIIiW SF:~TION <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 12~4 <br /> <br />4. F~B SCHraDULE (Complete ~nd emet total in Al below) <br /> <br />200 amps or less $50.00 2 <br />201 amps to 400 amp~ $60.00 2 <br />401 amps to 600 amps $100.00 2 <br />601 amps to 10O0 amps $1~0.0O 2 <br /> <br /> 200 amps or less $35.00 2 <br /> 201 aml~ to 400 ~raps $40.00 2 <br /> <br /> b) The f== for branch cimuits without <br /> purchase of service or feeder fee <br /> Ftmt branch circuit <br /> Each additional branch cimuit J <br /> <br />E. Mi~eellaneoua (~a'vice or t%eder Ha <br />Each pump or irrigation circle $40.00 <br />Each sign or outline lighting $40.00 2 <br />Signal clreuiKs) ora limited energy <br />panel, alteration or extension $40.00 2 <br />F. Each additional Inspection <br />Over thc allowable in any of the <br />above, per Impectinn $35 <br />O. Minor Installation Labels <br />Pack of 10 labels ~ $5.00 each $50.00 <br />Isold only to electrical contractors) <br />H. Other <br />(As required by Building O~ciM) <br />Aurora Dwelling £1ectrieal Fee sq. l[ x$.06 =__ <br />Dwelling Permit Label # of Labels. ~/C <br /> <br />$3s.0o <br />$ 2.0o <br /> <br />5. FEES Al. Enter total of fees from Sec. ~4 <br /> A2. Add .$% surcharge (.05 x Al) <br /> <br />~btotal <br /> <br />B. Eater25% of lineAl forPlanReview <br /> (Sec. 3), if required <br />C. Investlgat/on Fee (if r~qttir~d) <br />D. Reinspeetion lee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ 'g r", p'fi' <br /> <br /> <br />