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FOR CITY VALIDATION <br />Reeeiwd by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line; 588-7904 <br />Office: 588-5147 8:00 a.m, - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, i through 5 <br /> <br />PERMITS ARE NON-TRANSPERABLE AND EXPIRE IF WORK IS NOT <br />STA RT~D WITHIN 180 DAYS OF ISSUANCE OR iF <br /> WORK IS SUSPENDED FOR IS0 DAYS, <br /> <br />cONTRACTOR INSTALLATION oNLY <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />I~opet~y Owner (ploasc~ print) <br /> <br /> Mailing Address Phone <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5 B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 12/¢4 <br /> <br />4. F~.1:I scHI~D~]~ (Complele and enlet IOIM iu A 1 below) <br /> <br />A- <br /> Pet <br /> U~tlt <br /> <br /> 1000 sq, fi, or less $85.(Y0 4 <br /> or t~olaion thereo£ $15,00 <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> <br /> Installation, Alteration, ~ Relocation <br /> <br /> a) The fee Dr branch ob'cults <br /> p.~e¢,Oer fee <br /> <br /> Each *ddaional branch ¢imuil <br /> <br />E- Mi~llan~O~ (8~vioe ov F~m Not Include) <br /> ~¢h pump or imgution ci~le <br /> ~h si~ or outline lighting <br /> Signal ci~ uil(s) or a limited energy <br /> <br />~. ga~ additional lamp.flea ~er the allowabl~ <br /> <br /> ~¢~ el 10 labels ~ $5.~ each <br /> <br />IL Oth~ <br /> (~ requizvd by Building O~ciM) <br /> <br />$50.00 ...... 2 <br />$60,00 , g <br />$100.00 ~ 2 <br />$130.00 2 <br />$300,00 2 <br /> $40.00 __ 2 <br /> <br />$35.00 _-- 2 <br />$40.00 .... 2 <br />$80,00 2 <br /> <br />$ 2.(X) <br /> <br />$35.00 <br />$ 2.00 __ <br /> <br />$40.00 2 <br />$~).00 .... 2 <br /> <br />$40.00 2 <br /> <br />$35,00 __ <br /> <br />$50,00 __ <br /> <br />__~, lL x $,06 =__ <br /># (If Lahels <br /> <br />5- FEES <br /> A 1, Enter ttmd of fees iix>an $¢o,//4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of lille Al ibr Plan Review <br /> (Sec. 3), if required <br />C, Investlgation Fee (if required) <br />D. Reinspeelion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. __ <br /> <br />$ <br />$ <br /> <br /> <br />