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FOR CITY VALIDATION] <br />Received by: J <br />Date: ] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Churc~h St NE * Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Insp~tion Linv: 588-3904 <br />Office: 588-§147 8:00 n.m. - 4:30 pan. <br />FAX: §88-7943 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~ectiotl$, I through 5 <br /> <br />i. LOCATION OF ]lqSTAJ.,LATION <br /> <br />Dir~tlorm <br /> <br />PERMITS ARE NON.TRANSP'ERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED ~OR IS0 DAYS, <br /> <br />2B_ FOR OWNI/R INSTALLATIONS <br /> <br />Pmpeny Owner Olease prinO <br /> <br /> City/State/Zip <br /> <br /> Owner's Signature: <br /> <br /> 3. PLANREVIEW SECTION <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 applicatiom <br />g~7 As-J4 12~Y4 <br /> <br />4. FEI~ SCHEDUL~ (Co~plele al~d ente~ ~tal ia Al b~low) <br /> <br />10~ sq. fl. or Ic~ $85,~ .4 <br />~ch additional 5~ sq. fl. <br /> or ~n ~a~f $15,~ <br />~m/tcd Enemy $20,~ ~1 <br />~ch Manufactured Home or Modulae <br /> <br />200 amps or le~s $50.00 <br />201 amps to 400 amps $60.00 <br />401 amps lo 600 amps $100,00 <br />fi0I amps lo 1000 *mpa $130.00 <br />Over 1000 amps or volla ~300,00 <br />Reconnect only $40.00 <br /> <br /> 200 amps oe leto $35,00 <br /> 201 amps lo 400 amp~ $40,00 <br /> 401 amps to 600 amps $~0.00 <br /> Over 600 cups (It 1000 voh.~ <br /> <br /> p~u~:ha~26gdL~ l~edet fee <br /> <br />Each additional branch circuit ~ $ 2.00 <br /> <br />MJ~e~llan~oun (S~viee ~ Ft~de~ N~ Include) <br /> <br />$1gaal eireuiffs) or a limited envy <br /> <br /> m/,//, x $.06 =__ <br />Dwelling Permit Label # of Labels__ N/C <br /> <br />Al. Em*h' total of fee~ From Sec. #4 <br />A2. Add 5% sumhargo 605 x Al) <br /> Subtotal $___ <br /> <br />B, Enter 25% of line A 1 for Plan Review <br />(Scm 3}, if required $.__ <br />Cl lnve~tlgafion Fee (if required) <br />D. Reimpeetion Fee ($25.~) $.~ <br /> <br /> TOT~ ~OU~ DUE $ <br /> Receipt No,~ <br /> <br /> <br />