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FOR CITY VALIDATION Received by: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE ° Room 132 Salem, OR 97301 24 Hr Inspection Line: 588-7904 Off.we: 588-5147 8:00 a,m, = 4:30 p.m. FAX: 588-7948 ELECTRICAL PERMIT APPLICATION P/ease complete ~!1 Sections, I through 5 1. LOCATION OF INSTALLATION ,ob Add s 0/"'/e7',- 3T Directions Description PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAY'S OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. ~. OHTRACTOR INSTALLATION ONLY ~Electricai Con trac ,or _~ ~.~OO-a4,,%. I Phone Mailing Address Contractor's License No. .2J.~ ~ ~ gg C.-- Contractor's Board Reg. No. ~O~{a Job No. Signature of Supervising Electrician ~ ~ Supervisor's License No. ~/(O ~ [Phone ~'~-~ ~ ~.. ~/~' 2B. FOR OWNER INSTALLATIONS Property Owner (please print) Mailing Address I Phone City/State/Zip Owner's Signature: :3. PLANREVIRW 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. MC 15-34 12/94 PERMIT NO: Date: Issued by: 4. FEB SCHr:LDULB (Complete and enter total in Al below) Number oflnspections per permit allowed A. Re~idantiai Per Unit Service Included: Items Co~t (each) Sum 1000 sq, fl. or less $85.00 Each additional 500 sq. ft. or portion thereof $15.00 Limited Energy $20.00 __1 Each Manufactured Home or Modular Dwelling Service or Feeder $40.00 Services or Feeders (Does not include branch circuits, see section D) Installation, Alteration or Relocation 200 amps or less / $50.00 ~ 2 201 amps 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 401 amps to 600 amps Over 600 amps or 1000 volts see "B~ above D. Branch Circuits New, Alterations, or Extension Pot Panel a) The fee for branch circuits ~ gur~ase of service of feeder fee Each branch circuit $35.00 ~ 2 $40.00 ~ 2 $80.00 ~ 2 2.oo b) The fee for branch circuits _without purchase of service or feeder fee First branch circuit Each addltional branch circuit $35.00 $2.00 E. Miscellaneous (Service or Fe~ler Not Inohded) 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 $40.00 F. Each additional Inspection Over the allowable in any of the above, per Inspection $35.00 G. Minor Installation Labels Pack of 10 labels @ $5.00 each $50.00 (sold only to electrical contractors) H. Other (As required by Building Ollh;ial) Aurora Dwelling Electrical Fee Dwelling Permit Label ~.sq, tl. x$.05 = ~ # of Labels. N/C FEES Al. Enter total of t~es from Sec. #4 $ A2. Add 5% surcharge (.05 x Al) $'~'~O Subtotal $.~ B. Enter 25% of line A 1 for Plan Review (Sec. 3), if required $.~ C. Investigation Fee (if required) $ D. Reinspection Fee ($25.00) $ TOTAL AMOUNT DUE SY7 Receipt No.