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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 Ht Inspection Line: 5S~.7904 <br />Offi,:eg 588-5147 8:00 a.m. - 4:30 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> I <br />Please complete ail Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />pERMITS ARE NON-TRANSFeRABLE AND I~XFIRE IP WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDIiD FOR IS0 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Job No- <br /> <br />FOR OWNER INSTALLATIONS <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 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4, FEll SCI-IEDULE (Complclc and enter total il, A 1 below) <br /> <br />~¢h addit~l 5~ sq. <br /> <br />Limited Energy <br /> <br />200 amps or less $50.00 -- 2 <br />201 amp~ to 400 amim $60,00 -- 2 <br />401 amps to (~)0 alllp8 $100,00 -- 2 <br />601 amps to 1000 mpa $130.00 -- 2 <br />Ovcr 1000 amps or volta $900.00 -- 2 <br />Rcconncct only $40.00 -- 2 <br /> <br />E. Mi~eoflan(q, us (Sm-vice or Feeder Not <br />~¢h pump or i~igation ~imla ,, / $~.00 ~ 2 <br /> ~ch si~ or o~tlin~ Iightin8 $~.00 2 <br /> Signal eimuit(s) or a limited ell¢lgy <br /> <br /> above, pet Inspection $35.00 <br /> Pack of I0 labels ~ $5,00 cach $50,00 <br /> <br /> (~ required by Boildi~' O~c/~O <br /> Dwelling PennR ~beI ~ of ~bels. _ N/C <br /> <br />FEES <br />A I. Enter total of fees from Seo, #4 $ <br />A2. Add 5% surcharge 605 x Al) $_~.~ <br /> 8t~btotal <br /> <br /> B. ~tor 25% of line A 1 Ibr Plan R~view <br /> (Sc~. 3), if required $. <br /> C, Investigation Fcc (if required) <br /> D. Rgimpeotion Fee ($25,~) $_~ <br /> <br /> TOT~ ~OU~ DUE <br /> Receipt No. ~ <br /> <br />MC 15-.14 l*-/94 <br /> <br /> <br />