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FOR CITY VALIDATION <br />Reoeived by: <br />Date: <br /> <br />MARION COUHTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF I~STALLATION <br />Job Address 3 <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPEHDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FBB SCHEDULE (Complete and enter total in A l below) <br /> <br /> S~vie~ Inelud~d: Items Cost (each) S <br /> nmi <br />1000 sq. ft. or less $85.00 4 <br />~ach additional 500 sq. ft. <br /> or portion thereof $15.00 -- <br />Limited Energy $20.00 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Fee. der $40.00 2 <br /> <br />B. 8er vi~a or F~der a (Does not ineinda branch ¢irguits, ace section D) <br /> <br /> 200 amps or leas $50.00 -- 2 <br /> 201 amps to400amps $60.00 __2 <br /> 401 amps to 600 amps $100.00 __2 <br /> 601 amps to 1000 amps $130.00 2 <br /> Over 1000 amps or volts $300.00 -- 2 <br /> Reconnect only $40.00 -- 2 <br /> <br /> Installation, Alt~ratin~, or Relocation <br /> 200 amps or le~sa $35.00 2 <br /> 201 amps to 400 amps $40.00 2 <br /> 401 amps to 600 amps $80.00 <br /> Over 600 amps or 1000 volts <br /> <br />Supervlsor's Liceme No. <br /> <br /> FOR OWNBR INSTALLATIONS <br /> <br /> Propedy Owner (ple~sopriat) <br /> Ma/l/rig Address I ~one <br /> City/State, Zip <br /> Owner's Signature: <br /> <br /> 3. PLANRBVIBW SBCTION <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 />]dC 15-34 1/96 <br /> <br /> b) The fee for branch circuits without <br /> <br /> FirSt branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Not Includod) <br /> Each pump or irrigation uirele <br /> Each sign or outline lighting <br /> Signal circuit(s) ora limited energy <br /> panel, alt~ratinn or extension <br />F. Each additional Ii~p~ction <br /> Ovec the allowable in any of the <br /> above, per Inspection <br />O, Minor inatallatinn Labels <br /> Pack of 10 labels @ $5.00 <br /> (sold only lo electriesl cottt£actoc$) <br />H. Othor <br /> (As required by Building Ofl-wiM) <br /> Aurora Dwelling Eleglrieal Fee <br /> Dwelling Permit Label <br /> <br />$ 2.00 -- <br /> <br />$35.00~ <br />$ 2.00 <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />--~q.flx $.068 - <br />#ofLabels <br /> <br />NIC <br /> <br />5. FEE8 <br /> Al. Enter total of fees foam Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if rcquimd <br /> C. Investigation F~ (if requh~d) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AlVlOLr/qT DUE <br /> Receipt No. <br /> <br /> <br />