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~ MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CEN'I~R <br /> 255 Church St NE ' Room 1311 PEHM[T NO: <br />FOR CITY VALIDATION Salem, OR 97301 <br />Re~eive~l by: ~ C <br /> <br /> or ~ion ~emof $15.(~ <br /> Limiled ~nergy $20.~ <br /> <br />De~cfiptlon <br /> <br /> PIgRMITS ARIg NON-TRANSESRABLR AND F. XPIR~ IF WORKIS NOT <br /> STARTED WITHIN 1 ~0 DAYS OF ISSUANCii OR IF <br /> WORK IS SUSPENDED POR 18~ DAYS, <br /> <br />2A. COiSrrRACTOR INSTALLATION ONLY <br /> <br />Mailing Addle <br /> <br /> I <br /> <br />Conh'a¢lor's License No, <br /> <br />SU~rvisor's t,i¢~nse No, ,,, { Phon~ <br /> <br />2B, FOR OWNIgR IiNSTALLATION$ <br /> <br />MailingAddlv:ss ?~ ~0)t~ ~ <br /> <br />3, PLAN RIgVIBW $~CTION <br /> <br /> Marion County does not require a plan review. <br /> We will pwvide plan review service if you complete <br /> Section 5B and submit two (:2) sets of plans and <br /> specifications with this application. <br />~ z~-34/ff/~ " <br /> <br />Each M~nul~¢tt~rad Home oe Modular <br /> <br /> $50,~ <br /> 201 ~m~ to ~)0 amp~ -,. $~,00 2 <br /> 401 am~ to ~0 amps $ I ~.00 ~ 2 <br /> ~ 1 a~ps to 1000 ~ps $130,00 ...... 2 <br /> Ov~ 10~ amps or volta $3~.~ 2 <br /> <br />C, T~mp~ary <br /> <br /> 200 amps or I~ $35,00 2 <br /> ~1 amps to ~0 ~pa $~,00 ~ 2 <br /> <br /> ~e 600 ~ps or 10~ volta <br /> <br />D, Bt~neh Ck~its <br /> <br /> p~hage o~ s~iee of feeder <br /> ~oh bran& oi~uit $ 2.~ ,., <br /> <br /> b) ~e f~ f~ br~oh ei~ui~ without <br /> <br /> Fi~t b~ch e~uit $35.~ <br /> ~eh addJtlo~RI br~oh elg~g ~ $ ~,~ ..... <br /> <br /> Signal eimui~) or a limi~d <br /> <br />~ lh~ allowable in any of ~e <br />a~ve~ pot Impe~tion ~ $~5,~ .... <br />O. Min~ lnst~lhtlon Lab~ <br />Pack of I0 labels ~ $$.~ each <br />(~dd ~ly to eleatrieM contgactor~) <br />H. Otb= <br />(~ reqMmd OF ~ildi~ O~ciaO <br /> <br />5, Al, H~lter total of fees from See. <br /> A2. Add 5% surcharge (,05 X Al) <br /> <br />Subtotal <br /> <br /> <br />