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FOR CITY VALIDATION[ Received by:. Date: Salem, OR 97301 MARION COUNTY BUILDING INSPECTION 285 Church St NE · Room 132 pI=RMIT NO:_ 24 hr. Inspection Line 373-4427 Office: Phone 588-5147 8:00am - 4:30pm FAX: $88-7948 ELECTRICAL PERMIT APPLICATION I Please complete all Sections, I through 5 I I. LOCATION OF INSTALLATION , , ST~ ~ 1~ DAYS OF ISSU~ OR IF Issued by: ~ 4. ~E]~ SCH~D~-L~ (Complete and eater total in A1 below) A. Realdential Per Unit Nmnber ofI~pecfions p~ ~it allowo,, q~ ~vi~ lnclud~: Itaw~ ~st (each) Su mt 1~ sq. fi. ~ less $85.~ 4 ~eh adthtionfl 5~ sq. ft. or ~ion ~e~f $15.~ ~eh M~ufactu~ H~e or Mo~l~ ~elling Se~ice or ~er ~ M0.~ B. S~vi~ ~ F~a (~ not incl~e branch ciguit~ s~e s~ction D) Installation, Alteration o~ Relocation 200 amps or less $50.00 2 201 amps to 400 amps $60.00 2 401 amps to 600 amps $i00.00 2 601 amps to 1000 araps $I30.00 2 Over 1000 amps or volts $300.00 2 Reconnect only $40.00 2 C. Temporary Servi~a/Fe~d~rs Installation, Alteration, or Relocation 200 amps or less $35.00 2 201 amps to 400 amps $40.00 2 401 amps to 600 amps $80.00 2 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 service of feeder fee ff~ Each branch circuit $ 2.00 -- b) The fee for branch circuits without nurchaae of service or feeder fee First branch circuit Each additional br~qch circuit $35.00 $ 2.00 Phone~ 2B. FOR OWNBR INSTALLATIONS Property Owner (pleavgprint) Msiling Address I one City/State/Zip Owner's Signature: 3. PLAN RBVIBW SBCTION Marion County docs 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 15-341/96 (Se~vie~or Feeder Hot Included) Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 2 Signal circuit(s) or a limited energy panel, alteration or extension $40.00 2 F. Each addhional In~p~tioa Over the allowable in any of the above, per lmpection $35.00 G. Minor Installation Labels Pack of 10 labels @ $5.00 each $50.00 (sold only to olectrieM contractors) H. Other (As r~l~ired by Bnilding OIFtcisl) Aurora Dwelling Electrical Fee Dwelling Permit Label # of Labels N/C sq. fi. x $,068 = 5. FEES A 1. Enter total of fees from Se~. #4 $.__ A2. Add 5% surcharge 605 x Al) $.__ Subtotal $.__ B. Enter 25% of line A1 for Plan Review (Sec. 3), if required $.__ C. Investigation Fee (if required) $.__ D. Reinspeetinn Fee ($25.00) $.__ TOTAL AMOUNT DUE $.__ Receipt No.