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' 285 Church St NE' Room 132 <br />FOR CITY VA!.IDATION Salem OR 97301 I~ERMff NO~~ <br />Received by:. ' ' \ ' <br /> -- ' ' Date; -- <br />Date: I '~ 24 hr. Inspection Line 373-4427 ~. <br /> ~,X/ [ /} Office: Phone 588-5147 g:00am- 4:30pm . ___ <br /> ~ MI/ FAX: 588-7948 I$$ueo <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~ections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> DAYS OF ISSU~ OR IF <br />8US2~D~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FAectrical Contractor <br /> <br />Address <br /> <br />Phone# Fax~ <br />Property Owner Phon~ <br /> <br />Cona'actors LLc~ns~ No. <br />Comrac~or's Board l~g No. I Job No. <br /> <br />Si[return of Supervising Electrician <br />Supervisor's License No. ] Phone~ <br /> <br /> FOR OWHBR INSTALLATIONS <br /> <br /> 3. PLANRBVIBW 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 15-341/96 <br /> <br />4. FBE SCHBDULB (Complete and cate: total i~l below) <br /> <br />A. Residential Pe¢ Unit Number of Inspections per~.,it~ allowed -~ <br /> Service Included: Items Co~t (each) Sum i <br />IOO0 sq. fl. or less $85.00 4 <br />Each additional 500 sq, fl. <br /> or portion thereof $15.00 <br />Limded Energy $20.00 1 <br />Each Mnaufactor~d Home or Modular <br /> D~e or Feeder $40.00 2 <br /> <br />B. Seevice~ ~Peedee s~.Ooe~ not include branch circuits, see section D) <br /> <br /> 200 amps or less <br /> 201 amps Io 400 amps <br /> 40l amps to 600 amps <br /> 60l amps to 1000 amps <br /> Over 1000 amps or volta <br /> Reconnect only <br /> <br />C, Temp~ary l!~'viom/Fedd~a <br /> In~talintion, Alteration, or Rdoeation <br /> 200 amps or le~ <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 volts <br /> see ~B" above <br />D. Branch Cireulta <br /> N~wv, AIt~atinn~, or Emenalon Per Panel <br /> a) The fee for branch circuits ~ <br /> purchase of service of feeder fee <br /> Each branch circuit <br /> <br />b) The fee for branch circuits without <br /> <br />Rrst branch circuit <br />Each additional branch circuit <br /> <br />] $~0.00 ~0,oo2 <br /> $60.00 -- 2 <br /> $100.00 2 <br /> $130.00 2 <br /> $3OO.OO 2 <br /> $40.00 -- 2 <br /> <br />$35.OO -- 2 <br />$40.00 -- 2 <br />$80,00 -- 2 <br /> <br />~L-'" $ 2.OO/~)'00 <br /> <br />$35.00 <br />$2.oo__ <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />E. MiaceEaneo~s (~vineor Feeder No~ lneluddd) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuiKs)or a limited energy <br /> panel, alteration or extension <br />F. Each additional Inspection <br /> Over the allowable in nay of the <br /> above, per Inspection <br />G. Minor Installation Labeia <br /> Pack of 10 labels @ $5.00 each <br /> (sold only to elect~ca l contractors) <br />n. Othe~ <br /> (A~ required by Bnilding O~cial) <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />$35.00 -- <br />$50.00 <br /> <br /> sq. fl. x $.068 =__ <br /># Of L~hals N/C <br /> <br />5. FEES <br />Al. Enter totalof f~e~ from Sec.//4 <br />A2. Add 5% sureharg~ (.05 x Al) <br />~ Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (ifrequirdd) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />