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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Lin~ 588-7904 <br />Off'a:~: $$1-~147 8:00a.m.-4:30p.m. <br />FAX: $88-794.8 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through $ <br /> <br />L LOCATION OF INSTALLATION 9-17-96 <br />kmAdm~ 21856 Bents Road <br />c~ Aurora ] C~ S~ <br />Dhe~ 1-5 Exit 278 Uno~al <br /> <br />Rewire ATM Machines <br /> <br />PERMrrS ARE NON-TRANSfERABLE AND EXPh~E L= WORK IS NOT <br /> STARTED V~THRW 1 B0 DAYS OF ISSUANCE OR <br /> WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2~ CONTRACTOR INSTALLATION ONLY <br />EleeU~cal c~ctorElectrical Const. ] ~h~e 224--3511 <br />MailinsAdd~ t~.O. BeX 10286 - Portland. OR 9729 <br />Pmpe~O~mr First Interstate <br /> <br />Contractor's Licmse NO, 26-45C <br /> <br />Superv~or's License No. 2986S ] rhone 224-3511 <br /> <br />2IL FOR OWNFaR INSTALLATIONS <br /> <br />Property O~r (~prim) <br />Mailing Addw~ ] Phone <br />City/Smw~Zip <br />O~n~'s Signature: <br /> <br /> 3. PLAN'REVIEW SBCTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review set. ice 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 />PERMIT NO: <br />Datei <br /> <br />Issued by: <br /> <br />4. FBE SC}I~DULE (Complete and enter Iota! in Al b~low) <br /> Number of Inspections pet permit allowed --~ <br />A, <br /> Residential <br /> Per <br /> Unit <br />Service Included: Items Cc~t (each) Sum i <br />1000 sq. fL or less $85.00 4 <br />Each additionnl $00 aq. <br /> or potion thereof $15,00 <br />Limited Ener~, $20.00 1 <br /> <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />B. Se~,ieee or Feeders (Does not include branch circuits, nee section D) <br /> <br /> 200 amps or les~ <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 601 amps to 1000 amps <br /> O~er 1000 amps or ~olts <br /> <br />C. Temporary Serviees~eeders <br /> <br /> 200 amps or less <br /> 201 amps to 4~0 amps <br /> 401 e~nps to 600 amps <br /> Over 600 amps or 1000 volts <br /> <br /> a) The fee for branch ci~uits with <br /> Each branch <br /> b) The fee for branch ci~.uits without <br /> <br /> Fu~t 5nmch circuit <br /> Each additional branch circuit 4 <br /> <br />E. Miscellaneous (Service or Feeder Net Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circint(s) or a limited <br /> <br />F. E-~.h additional Inspection <br /> Over the allowable in any of the <br /> <br /> Pack of l0 lalmls ~ $5.00 e~eh <br /> (sold only {o electrical <br />H. Other <br /> (As req~vred by Buile~ng O[~eial) <br /> Aurora Dwelling Electrical <br /> Dwelling Permit Label <br /> <br />$50.00 2 <br />S60.00 2 <br />$100.00 2 <br />$130.00 2 <br />$300.00 2 <br />$40.00 2 <br /> <br />$35.~ 2 <br />$40~ 2 <br />$~.~ 2 <br /> <br />$ 2.(30 <br /> <br />s35.~ 35.00 <br />$ 2.00 ~.O0 <br /> <br />$40.00 2 <br />,~O.00 2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br /> sq. £ x $.06 =__ <br /># of Lahe~ bYC <br /> <br />5. FEES Al. Enter totalof fees fwm Sec. #4 <br /> A2. Add 5% surcha~gn 605 x Al) <br /> <br />~bto~al <br /> <br />B, Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if requi~d <br />C, Investigation Fee (if required) <br />D. Rclmpectlon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />S 43.00 <br />$ Z.lD <br /> <br />$ 45.15 <br /> <br /> <br />