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FOR CITY VALIDATION[ <br />R~eived by: <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE- Room 132 <br /> Salem. OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am ~ 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ~1 Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <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 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY' <br /> <br />Electrical Contractor ~[~ ~T~ ~Y~ [~ Phone <br /> Z03 NE HANCOCK <br />Mailing Address PORTL AND, OR 97212 . <br /> ,~xo (5~Jl ~8,3265 ~ ~ ~/ <br /> <br />Signature of Supervising Elec~¢ian~/' ~rt~ ~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print) <br /> <br />Mailing Address { Phone <br /> <br /> City/State/Zip <br /> <br /> Owner's Signature: <br /> <br />3. PLANRBVIRW SRCTION <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 />Date: <br /> ,wr',ntut~{ bOO{~l I Y <br />~ssu~lJ~.lNO INSPECTION <br /> <br /> 4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> A. Residential Per Unit Nmnber of Inspections per permit allowed ~ <br /> <br /> Service Included: ltenm Coat (each) Sum t <br /> J Li_.~litedl000 sq. ft. or less $85.00 4 <br /> Each additional 500 sq. ft. <br /> or portion thereof <br /> --'-7-- $15.00 <br /> Energy <br /> ~,-~,ach Manufactured Home or Modular <br />/[ Dwelling Service or Feeder $40.00 ~2 <br /> <br /> B. Servicea or F*oders (Does not include branch circuits, see section D) <br /> Installation, Alteration or Relo~ation <br /> 200 amps or less $50.00 __ 2 <br /> 201 amps to 400 amps $60.00 ~ 2 <br /> 401 amps to 600 amps $100.00 __ 2 <br /> 601 amps to 1000 amps $130.00 ~ 2 <br /> Over I000 amps or volts $300.00 __ 2 <br /> Reconnect only $40.00 __ 2 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alteration, or Relocation <br />200 amps or less $35.00 __ 2 <br />201 amps to 400 amps $40.00 __ 2 <br />401 mnps to 600 amps $80.00 ~2 <br />Over 600 amps or 1000 volts <br />see "B" above <br />D. Branch Circuits <br />New, Alterations, er Extension Per Panel <br />a) The fee for branch circuits _vgilh <br />purchase of service of feeder fee <br />Each branch circuit $ 2.00 __ <br /> <br />b) The fee for branch circuits without <br /> gurgl~m_o!~e_rvice _or feeder fee <br />First branch circuit <br />Each additional brtmch circnit <br /> <br />$35.00 <br />$ 2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br />Each pump or irrigation circle $40,00 ~ 2 <br />Each sign or outline lighting $40.00 ~ 2 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 ~ 2 <br />F. Each additional Inspection <br />Over the allowable in any of the <br />above, per Inspection $35.00 ~ <br />G. Minor Installation Labels <br />Pack of l0 labels @ $5.00 each $50.00 __ <br />(sold only to electrical contractors) <br />H. Other <br />(As required by Building Oil~ciaO <br />Aurora Dwelling Electrical Fee <br />Dwelling Permit Label N/C <br /> <br /> sq. fl. x $.068 =__ <br />//of Labels <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 lbr Plan Review <br /> (Sec. 3), if required $ __ <br /> C. Investigation Fee (if required) $__ <br /> D. Reinspection Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $ <br /> Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />