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FOR CITY VALIDATION [ <br />R~c*iv~l by: , ,, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPHCTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St HE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspeetion Line 373=4427 <br />Offke: Phone 588-5147 8:00nm - 4:3Opm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br /> PERMITS ARE EON-TRANSFERABLE AND EX~IRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE O~ IF t~'N~ , <br /> WORK IS SUSPENDED FOR 180 DAYS~{~x'~ ~ <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />MailingAddr~s '~J~[~O ~'~}~-,~-- '~1t ~ <br />Contractor's Licem~ No. 01 ~'l'"t <br /> <br />nat ~ o f Supervising Elgtri¢i~5.-~-~~-[.~ <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br />[Property Owner (ple~pril~) <br /> <br /> Mailing Address <br /> <br />ICity/State/Zip <br /> <br />_ Owner's signature: <br /> <br />Phone <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-$41/96 <br /> <br />PERMITNO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. ~ SCI-]t~DUL~ (Complete and enter total in Al b~low) <br /> Nmnb~ of Inspections per permit allowed -~ <br /> P~ <br /> Uait <br />S~'vi~ Included: It~m~ C~yat (e~eh) Sum <br />1000 ~1- fl- or less $85.00 4 <br />E~¢h additional .~0 sq. ft. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 1 <br />F~eh Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />E. 8atviees or F~ders (Does not include branch oiccuita, see s~JOn D) <br /> /nstallation, Alteration or Raloesticm <br /> 200 aml~ or le~ ~ S50.O0 ~O~ 2 <br /> 201 amps to ~ amps $~0.00 2 <br /> 401 amps to 600 amps $1{30.00 2 <br /> ~01 amps to 1000 ~nps $130.00 2 <br /> Over 1000 amt~ or volta $300.00 2 <br /> Reeom~¢t onl~ $40.00 .2 <br /> <br />b) 'l~c tee for bran*h dreuita wilhout <br /> <br />$35.~ <br />$2.~ <br /> <br />B. Miscellanzous (~erviee er Feeder Hot Ineinded) <br /> E~ch pump o~ irrigation <br /> 1K~ch sign or outline lighting <br /> Signal circuit(s) ora limited energy <br /> <br />F. Each additional inspeetiofl <br /> Ove~ the allowable in ~ny of the <br /> above, per Impection <br />(]. Minor lnstnllatlon Labels <br /> Pack of 10 labels ~ $5.00 each <br /> (sold only to electrical cot~rsctors) <br />H+ Othe~ <br /> (As required by Bnildin~ <br /> Aurora Dwelling Ele¢lrloal Fee <br /> l>,v~lting P~rmit <br /> <br />$40.00 2 <br />f~[0.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> ~q. fl. x $. 068 ~ -- <br />tt of Lab~b N/C <br /> <br />5, FEES <br /> A 1..Entar total of f~ from See. #4 <br /> A2. Add5% surabarg~ (.05 xAI) <br /> <br />B. Enter 25% of lln= A 1 for Plan Rmiew <br /> (Sec. 3), if requirod <br />C. Investigation Fee (if roquired) <br />D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUIqT DUll <br /> Receipt No. <br /> <br /> <br />