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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 />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> 24 hr, Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> 2B. FOR OWNBR INSTALLATIONS <br /> <br /> l~pcr~y Owner (,ol~se prim) <br /> ~ilin~ Add~s ~ ~ne <br /> City/Sm~tp <br /> Owner's Signat~e: <br /> <br /> 3. PL~R~EW SECTION <br /> <br /> ~rion Coun~ does not require a plan review. <br /> We will provide plan review se~ice if you complete <br /> Section 5B and submit ~o (2) sets of plans ~d <br /> specifications wi~ ~is application. <br /> <br />MC 15-34 1/96 <br /> <br /> 4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Setvie~ Included: Items Cost (each) Sum <br /> 1000 sq. fl, or leas $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 Feeders (Does not include branch circuits, see section D) <br /> · Insta~tion, Alte~a/ion or Rolocation <br /> 200 alnpa or less ~a~ $50.00 1OO2 <br /> 201 amps 1o 400 amps $60.00 2 <br /> 401 amps to 600 amps $100.00 __2 <br /> 601 amps to 1000 amps $1~0.00 2 <br /> Over 1000 amps or volts $300.00 2 <br /> Reconnect only $40.00 2 <br /> <br /> Each branch circuit I ~ <br /> <br />$ 2.00 .oO°° <br /> <br />b) The fee for branch circuits without <br /> g~hase of sekvice or feekler fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$35.00 <br />$ 2.00 <br /> <br />E. Miscellaneous (Servieo ar Fe~der Not Included) <br />Each pump or irdgaf~n circle $40.00 <br />Each sign or outline lighting $40.00 <br />Signal circuit(s) or a limited energy <br />panel, alteration or ex~nsion $40.00 <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, per lmpection $35,00 <br />O. Minar Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrics I cont£aetocs) <br />H. Other <br />(As re~tuired by ~tilding O[ftciaD <br /> Aurora Dwelling Electrical Fee __sq. fi. x $.068 - <br /> Dwelling Perrnit Label ff of Labels. <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 $'~l&OOO <br /> $ l~-~-O <br /> A2. Add 5% surcharge (.05 x Al) 8~btotal $~O~ <br /> <br /> B. Enter 25% orlJne Al for Plan Review <br /> (See. 3), if required $.__ <br /> C, Investigation Fee (if required) $__ <br /> D. Reinspection Fee ($25.00) $.__ <br /> TOTAL AMOUNT DUE $_L~,~._O <br /> Receipt No. __ <br /> <br /> <br />