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FOR CITY VALIDATION Received By: Date: BUILDING INSPECTION DIVISION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305-1398 24 HR lmpecflon Line 373.4427 Office: phone 588-5147 8:00am - 4:30pm FAX 588-7948 ELECTRICAL PERMIT APPLICATION I Please complete all Sections, 1 through 5 I /- 1. LOCATION OF INSTALLATION IJ°snvnrmss q2.°l~ ~t-4~xt,o qfot~g- ~O I lol l-lsl l ,I-I lw Io1 CR~S S~T/ D~O~S ~ILV~ F~LL~ ~ y P~s A~ ~ON-~S~ ~ ~ W WO~ IS NOT ST~D ~ 180 DAYS OF ISSU~CE OR W WO~ IS SUS~ FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY 2B. FOR OWNER INST~LLATIONS Property Owner ~lease print) Mailing Address City, State, Zip Owner's Signatu~ 3. PLAN REVIEW SECTION Marion County does not require a plan review. We w.1 provide plan review service if you complete Section 5B and submit two (2) sets of plans and I specifications with this application. MC 15-34 7/97 Date: Issued by: 4, FEE SCHEDULE (Complete and enter total in A1 below) A. Residential Per Unit Service Included: 1000 sq. fl. or less Each additional 500 sq. fl. $85.00 $15.00 $20.00 Services or Feeders (Does not include branch circuits, see section lmtaltation, Alteration or Relocation 200 amps or less I $50.00 ~ 201 amps to 400 amps $60.00 -- 401 amps to 600 amps $100.00 601 amps to 1000 amps $130.00 __. Over 1000 amps or volts $300.00 __ Reconnect only $40.00 C. 'I~nporary Servic~dFeeders Installation, Alterations, or Reioealion 200 amps or less $35.00 201 amps to 400 amps $40.00 401 amps to 600 amps $80.00 Over 600 amps or 1000 volts see "B' above D. Branch Clreutis New, Atierafion~ or Exte~lon Per Panel a) The fee for branch uimults with narchase of ~er~iee or feeder fee Each branch uircuit ~ $2.00 la) The fee for branch circuits without z*urchase of aerviee or feeder fee First branch circuit $35.00 Each additional branch circuit $2.00 E. Miscellaneous (Service or Feeder Not Included) Each pump or irrigation circle $40.00 __ Each sign or outline lighting $40.00 Signal circuit(s) or a limited energy panel, alteration or extension .$40.00 __ F. Each addltioanl Impeetioo Over the allowable in any of the above, per Inspection $35.00 G. Minor lnstalintioo Labels ?ack of 10 labels @$5.00 each $50.00 (sold o~ly to electrical contractors) H. Other (As required by Building Officials) Aurora Dwelling Electrical Fee sq. t~. x $.068 = -- Dwelling Permit Labd II of Labels.__ 5. FEES Al. Enter total of fees from Sec. g4 A2. Add 5% surcharge (.05 x Al) B. Enter 25% of line Al for Plan Review (Sec. 3), if reqaired C. Investigation Fee (if required) D. Reimpeetion Fee ($25.00) Receipt No. $ $ $ TOTAL AMOUNT DUE $~ ~.