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MARION COUHTY BUILDING INSPECTION <br /> <br /> COMMUNITY DEVELOPMENT CENTER <br />FOR C Salem, OR 97301 <br /> Office: Pho~m - 4:30pm <br /> <br />ELEC'FRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERh~rs ARE NON'TRANSI~RABLE AND I~XPIRE IF WORK IS NOT <br /> STARTI~ W1THIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPFaNDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Address <br /> <br />Preperty Owner Phone// <br /> <br />Contractors License 1%. <br />Contractor's Board R~g No. I ,ob No. <br /> <br />Signature of Su~ising Electrician <br /> <br /> I <br />Supervisor's License No. ] Phoneg <br /> <br />2B. FOR OWNRR INSTALLATIONS <br /> <br /> 3. PLANRBVIBW SBCTION <br /> <br /> Marion County does not require a plan mviaw. <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-$4 1/96 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> (C~nplcte and cnt~ total in A1 below) <br /> Nmnber of Inspections per permit allowed <br /> <br /> ~lncluded: Items Cost (each) Sum ] <br />1000 sq. ft. or less $85.00 4 <br />Each additional 500 sq. fl. <br /> or portion thereof $15.00 <br />Limited ~nergy $20.00 1 <br />~ach Manufactured Home or Modular <br /> Dwelling Servic~ or Fe~der $40.130 -- 2 <br /> <br />2001nstallation'~mps or Ie~Alt~r atinn cr Relocation ~ $50,~ <br />201 amps to 400 amps -- $60.00 2 <br />401 amps to 600 amps __ $100.00 2 <br />601 amps to 1000 amps _ $130.00 2 <br />Over 10O0 amps or volts -- $300.00 2 <br />Reconnect only -- $40.00 2 <br /> <br /> a) The fee for branch circuits ~ <br /> <br />E. Miaceiinneous (Servieecr Feeder Not lneluded) <br />Each pump or i~dgntion circle $40.00 -- <br />Each sign or outline lighting $40.00 -- <br />Signal circuit(s) ora limited energy <br />panel, alteration or extension $40.00 -- <br />F. Each additional lnspeetlon <br />Over the allowable in any of the <br />above, pst Inspection $35.00 -- <br />G. Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 -- <br />(sold only to electrical contractors) <br /> <br /> ~q. fi. x $.068 = ' <br /># Of Labels N[(~ <br /> <br />5. FEES <br /> Al. Enter Iotal of fees from S~.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> ~ubtotal <br /> <br /> B. Enter 25% of line Al for Plnn Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> R~ceipt No. <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />