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FOR CITY VALIDATION Received by: Date: ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 1. LOCATION OF INSTALLATION MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 7~ Salem, OR 97301 24 hr. Inspection Line 373-4427 Office: Phone $88-5147 8:00am - 4:30pm FAX: 588-7948 PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. COHTRACTOR INSTALLATION ONLY Electrical Contractor Phone Mailing Address Property Owner Phone Contractor's License No. Contractor's Board Reg. No. Job No. Signature of Supervising Electrician Superviaor's License No. Phone 2B. FOR OWNI~ INSTALLATIONS 3. PLANRBVIRW 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. FEE SCHEDULE (Complete and enter total in Al below) Nmnber of Inspections per permit allowed -~ Re,[dent[al Per Unit ! Service Included: Items Cost (each) Sum 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 $40.00 __ 2 B. 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 Per Panel a) The fee for branch circuits with purchase of s_e_~[~.9_f feeder fee Each branch circuit b) The fee for branch circuits without purchase of se~r~_ige~r feeder fee First branch circuit Each additional [)ranch circuit E. Miscellaneous (Service or Feeder Hot Included) Each pump or irrigation circle Each sign or outline lighting Signal circuit(s) or a limited energy panel, alteration or extension F. Each additional Inspection Over the allowable in any of the above, per Inspection Gl. Minor Installation Labels Pack of 10 labels @ $5.00 each (sold only to electrical contractors) H. Other (As required by Building Olticial) Aurora Dwelling Electrical Fee Dwelling Permit Label $35.00 __ 2 $40.00 __ 2 $80.00 __ 2 $ 2.00 $35.00 $ 2.00 $40.00 __2 $40.00 ~ 2 $40.00 __2 $35.00 __ $50.0O __ --$q. fl. x $. 068 = __ # of Labels N/C 5. FEES Al. Enter total of fees from Sec. #4 $.__ A2. Add 5% surcharge (.05 x Al) $.__ Subtotal $.~ B. Enter 25% of line A 1 for Plan Review (Sec. 3), if required $.__ C. Investigation Fee (if required) $.__ D. Reinspcction Fee ($25.00) $.__ TOTAL AMOUNT DUE $.~ Receipt No. MC 15-34 1/96