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COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 FOR CITY VALIDATION Received by: Date: 24 hr. Inspection Line 373-4427 Office: Phone 588-5147 8:00am - 4:30pm FAX: 588-7948 ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 5 I ~/ATION OF INSTALLATIO~q 4 7 I PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. Mailing Address ~ Fi~ BO'~ ~O~?J~ Property Owner I Phone Contractor's License No. ,Contractor's Board Reg. No. Job No. Phone Signature of Supervising Eiec~ci.~_.__ ~_______. Supervisor's Li~mse._Ro- q , 2~. FOR OWI~R I~$TALLA?ION$ Property Owner (please print) MaiMing Address I Phone City/State/Zip Owner's Signature: 3. PLANREVIBW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. PERMIT NO' Date: Issued by: 4. FBB SCHEDULB (Complete and enter total in Al below) Number of Inspections per permit allowed -----j Rmidential Per t/nit ! Sorviee Included: ltema Coat (each) Sum I 1000 sq. ft. or less $85.00 4 Each additional 500 sq. ft. or portion thereof $15.00 Limited Energy $20.00 1 Each Manufactured Home or Modular Dwelling Service or Feeder M0.00 ~ 2 B. Services or Feeders (Does not include branch circui~ see section D) Installation, Alteration or Relooation 200 amps or less $50.00 ~ 2 201 mnps to 400 amps $60.00 -- 2 401 amps to 600 amps $100.00 ~ 2 601 amps to 1000 amps $130.00 __2 Over 1000 amps or volts $300.00 ~ 2 Reconnect only $40.00 ~ 2 C. Temporary ,Services/Feeders Installation, Alteration, or Relocation 200 amps or less 201 amps to 400 amps 40 1 amps to 600 amps Over 600 amps or 1000 volts see 'B~ above D. Branch Circuits N~.v, Alterations, or Extension Per Panel a) The fee for branch circuits with purchase of service of feeder fee Each branch circuit $35.00 __ 2 $40.00 ~ 2 $~0.00 ~ 2 $ 2.00 b) The fee for branch circuits without purchase of service or feeder fee Fimt branch circuit Each additional branch circuit $35.OO $ 2.00 E. Miscellaneous (Service or Feeder Not Included) Each pump or irrigation circle $40.00 Each sign or outline lighting $40.00 Signal circuit(s) or a limited energy panel, alteration or extension 2540.00 P. Each additional inspection Over the allowable in any of the above, per Inspection $35.OO O. Minor Installation Labels Peck of 10 labels @ $5.00 each $50.00 (sold only to electrical contractors) H. Other (As required by Building Official) Aurora Dwelling Electrical Fee Dwelling Permit Label __.sq. fi. x $.068 = ~ # of Labels N/C 2 2 2 5. FEES Al. Enter total of fees from Sec.//4 $.~ A2. Add 5% surcharge (.05 x Al) $.~ ~ubtotal $.~ B. Enter 25% of line Al for Plan Review (Sec. 3), if required $ C. Investigation Fee (if required) $ D. Reinspecfion Fee ($25.00) $~ Receipt No. MC 15-34 1/96