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FOR CITY VALIDATION] <br />Received by: I <br />Date: ] <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> P/ease complete all Sections, I through 5 <br /> <br />l. LOCATION OF INSTALLATION <br /> <br />2obAddr~s 638 Windemere St #19 <br />ci~ Aumsville Ices st. Main <br />D~om Left on Main, cross RR tracks <br /> <br /> Left into park. _ <br /> 2.5 ton heat pump add-on <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 150 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br />Elec~icalContra¢~or B.Warrington [ Phone 585-5889 <br />Mailmg^ddrcss 3760 Market St NE #311 Salem <br /> <br />~ope,yOwner M.Veneman [ Phone 749-131 2 <br />Contractor's Liemse No. 2 4 - 3 3 4 - C <br /> <br />Contractor's Board Reg. No. 104529 I Job No. <br />Signature of Supervising Electrician /~~ <br />Superviaor'sLieenseNo. 4003-S -- [ Phone 585-5889 <br /> <br /> liB. FOR OWNBR INSTALLATIONS <br /> <br /> P~periy Owner (please print) <br /> Mailing Address I Phone <br /> City/S~ateJZip <br /> <br /> 3. PLANRBVIEW 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 />MC 15-34 <br /> <br />M~d~/ON COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 ~urch St NE · R~m 132 PER <br /> Salem, OR 97301 e:~ <br /> ~ Hr In~tion Lh~e: 58~7~ Dst <br /> <br />4. FBB $CHBDUL~ (Complale and enter total in Al below) <br /> <br /> mt <br />1~ sq. ~. ~ less $85.~ 4 <br /> <br />~mited Energy $20.~ 1 <br />~ch Manufactured Home or Modular <br /> <br /> 200 amps or less $50.00 2 <br /> 201 amps to 400 amps $60.00 -- 2 <br /> 401 amps to ~00 amps $100.00 -- 2 <br /> 601ampsto 1000amps $130.00 __2 <br /> Over 1000 amps or volts $300.00 __ 2 <br /> Reconnect only $40.00 -- 2 <br /> <br />C. Temporary ,,~'vDea/Feedere <br />lnstalintion, Alteration, or Relocation <br />200 amps or less $35.00 2 <br />201 amps to 400 amps $40.00 2 <br />401 maps to 600 amps $80.00 2 <br />Over 600 amps or 1000 volts <br /> <br />D. Branch Cirouits <br /> <br /> a) The fee for breach c[rcints ~ <br /> purchase of service of feeder fee <br /> Each branch circuit $ 2.00 <br /> <br />b) '~he fee for branch circuits without <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />1 $35.00 3 5.0 ( <br /> $ 2.oo __ <br /> <br />E. Miaoellaneous (8erviceor Feeder NOt Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Sigr~l 0ireuit(s) or e limited energy <br /> panel, alteration or extension <br />F. Each additional Inspection <br /> Over the allowable in any of the <br /> above, per Inspection <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5.~0 each <br /> (sold only to electrical cor~tractors) <br />H. Oth~ <br /> (As required by Building Ol~ciM) <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />:$40.00 <br />$40.00 <br /> <br />$40.00 2 <br /> <br />$35.00 -- <br />$50.00 <br /> <br /> ~. It x $.06 =__ <br /># of Labels NIC <br /> <br />5. FEES Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if r~quired <br />C. Investigation Fee (if required) <br />D. Reimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> (o'95 <br /> <br /> <br />