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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />285 Church St NE · Room Salem, OR 97301 <br /> <br />ELECTR,CAL PERMIT APPLICATIONI <br />Please complete all Sections, I through 5 I ,... <br /> <br />PERMITS ARE NO~]/~S FERA BLE AND ~PIRE IF WORK IS NOT <br /> <br />STARTED WITtnN 180 DAYS OF ISSUANCE OR IF <br />WORK iS SUSP£NDI~D FOR IlO DAYS. <br /> <br />Issu b UILDING '" <br /> <br />24 Hr lasp~tion Lin~ 588-7904 <br />Offg~: 588-5147 8:00 a,m, - 4:30 pan, <br />FAX: 588~7948 <br /> <br /> 4. ~]~ $CH]~UL~ (Complete and enter ImM in AL b~low) <br /> <br /> Rmidomial <br /> Unit <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Add.ss <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> I~p¢~ty Owner ~l~e ~ria0 <br /> Mailing Addrras j Phone <br /> Chy/StateJZiD <br /> Owner's Signature: <br /> <br />3, PLAN RI~VI]~W SECTION <br /> <br />200 amps or less $~).0(l __ 2 <br />201 amps to 400 omp* $60,00 ......... 2 <br /> <br />Marion County does not require a plan review, <br />We will provide plan review service if you complete <br />Sectkm 5B and submit two (2) sets of plans and <br />specifications with this application, <br /> <br />$35.00 <br />$ 2,oo <br /> <br />E. Miscellaneous (Sexvieo m- P~vr Ncl Include, l) <br /> F~h pump or iffJgatioa circle <br /> Each sigm or outline lighting <br /> S~nal e~uil(s) or a limited en~gy <br /> <br />P, Ea~ additional Inap~tion <br /> Over the allowable in any of ~e <br /> <br />~, MJn~ Installation Labels <br /> Pack of 10 labels ~ $5,00 each <br /> (~ld only to electrleal contractors) <br /> <br /> (~ raqmrad by Build~ O~c]a0 <br /> Au~ra Dwelling ~leetdeal Fee <br /> <br />$40.00 2 <br />$40,00 2 <br /> <br />$40,00 2 <br /> <br />$35.00 __ <br />$50.00 <br /> <br />I~, g.x$,06 =I <br /># 0f Labels. .~1~_. <br /> <br />5. EEES Al. Enter total of fees l¥om S~, fi4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />~ L¢-,t4 <br /> <br /> <br />