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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br />! FOR CITY VALIDATION [ 255 Church St NE · Room 132 P£RMff NO: 9t'[ <br /> R~eived by:, _ Salem, OR 97301 <br /> Date: _ Dato: <br /> 24 hr. Inspection Line 37~-4427 <br /> Office: Phone 588-5147 8'00aim - 4'30pm <br /> <br /> ELECTRICAL PERMIT APPLICATION "T"'-' ~ .... <br /> Please complete all Sections. l through ~L~ 3 1 4. FE~SCH~UCE(Comp,ete~.d~m=rto=~.,Atb=iow) <br /> <br /> Re~idenfial ]Pea' Una Number o~insp¢ctions per permit allowcL- <br /> 1. LOCATION OF INSTALLATION M~,~ION ~rvio~ ln~luded: Items Coat(each) <br /> <br />Job Addr~s <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EX-PIRE IF WORK IS NOT <br />STARTED ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Phoneg <br /> <br />Job No. <br /> <br />Supervisor's License No. ~(~ I~ ~ <br /> <br />2B. FOR OWNI~R INSTALLATIONS <br /> <br />Property Owner (pl~as~prim) <br /> <br /> Mailing Address I Phone <br /> City/State/Zip <br /> <br /> 3. PLANRBVIEW $]~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 1/96 <br /> <br /> fl. or leas $85.00 4 <br />Each additional 500 sq. ft. <br /> or poaion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 -- 2 <br />B.~ Feeders (Does not include branch circuits, see section D) <br /> 200 amps or less I $50.00 5Oa~ <br /> <br /> 200 amps or less $35.00 2 <br /> <br />b) The fee for branch circuits without <br /> <br />First branch circuit <br />Each additional branch circuit <br /> <br />E. Mj~?lLan~a (~rvi~ ct Peede~ N~ Included) <br />· Each~or irrigation circle [ <br />Each sign or outline lighting <br />Signal ¢ircint(s) or a limited energy <br />panel, alteration or extension <br />F, Each additional In~p~otlon <br />Over the allowabl~ in any of the <br />above, per Inspection <br />Cl. Min~ Installation Labels <br />Pack of 10 labels @ $5.00 each <br />(sold only to electricM contractors) <br />H. Othor <br />(As required by Bnilding OBJciaD <br />Aurora Dwelling Eleclrical Fee <br /> Dwelling Permit Label <br /> <br />$35.~ <br />$2.~ <br /> <br />$4o.oo <br />$40.00 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />--$q. fl, x $.068 = <br />#of Lal~ls N/C <br /> <br />5. FEES <br /> A l. Enter total of fees from See. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter25% &lineAl forPlan Review <br /> (See. 3), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUlVr DUE <br /> Receipt No. <br /> <br />sqq, <br /> <br /> <br />