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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 Linc: 588-7904 <br />Offlco: 588-.5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF 13ISTALLATION <br /> <br />JobAddr s II/ g oF <br /> <br /> PER IvnTS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> START[il) WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR I80 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Reg, No. <br /> <br />Signature of Supervising Electrician <br /> <br />Supervisor's License No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prol~rty Owner (pleat~ prim) <br /> <br /> Mailing Address I Phone <br /> City/State/~lp <br /> <br /> 3. PLAN RBVIBW 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-J4 12/94 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEB SCHRDUL~ (Complete and enter totatin A1 below) <br /> <br />A. Residential Per Unit Nmnber of Inspections per permit allowe~ ~a <br /> 8ecvic~ Included: Items Cost (each) S <br />1000 sq. ft. or less $85.00 4 <br />Each additional 500 sq. ft. <br /> or portion thereof $15.00 -- <br />Limited Energy $20.00 __1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />B. Services or F~sl~ (Does not include branch circuits, s~ section D) <br /> <br />Installation, Alteration or Relo~ation <br />200 amps or less <br />201 amps to 400 amps <br />40l amps to 600 amps <br />601 amps to 1000 amps <br />Over 1000 amps or volts <br />Reconnect only <br /> <br />b) The fee for branch circuits without <br />Each additional branch circuit <br /> <br />$ o.oo <br />$60.00 2 <br />$1OO.OO 2 <br />$130.00 2 <br />$300.00 2 <br />$40.00 2 <br /> <br />$35.00 2 <br />$ffi.OO 2 <br /> <br />$ 2.00 -- <br /> <br />$35.00 -- <br /> <br />B. Mi~collaneo~ (8ea'viceor F~der Not lnolu~) <br /> <br /> ~ch si~ or outline light~g <br /> Sign~ circuit(s) or a limit~ <br /> <br /> Over the allowable in any of ~e <br /> <br />O. Min~ Installation Labels <br /> Pack of 10 labels ~ $5.00 each <br /> (s~d only to electdcal co~ractors) <br /> <br /> (~ required by ~itdi~ O~tci~O <br /> Amra Dwelling Electrical F~ <br /> <br />$35.00 -- <br />$50.OO __ <br /> <br />__sq. 8. x$.06 =__ <br />tt of Labels N/C <br /> <br />5. FEES Al. Enter total of fees from Sec,//4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <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. Reimpeetion Fee ($25.00) <br /> <br /> Receipt No. 3 ~TTO,~AMO~IT DUE <br /> <br /> <br />