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FOR CITY VALIDATION' <br />Received by: <br />Date: <br /> <br />COMMUNrr¥ DEWL?.PMENT CENTER <br />285 Church St NE Room 132VErY NO /lJJ <br /> Salem, OR97301 ~ J~)~.'~ ~ ~$'" ~ <br /> Date: <br /> ~ Ht Ina~tloa Lb~ 58~7~4 ~ i~iOl~ CUUN 1 Y <br /> orate: ~ss-~4~ s:~.~.-~:3op.m. I~u~ ~ILD[NG INSPECTION <br /> P~: 58~-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION .] <br /> <br />Please complete all Sectioos, 1 through 5 <br /> <br />PERMrrs ARE NON-TRANSFERABLE AND EXPIRE IF wORK IS NOT <br />STARTED WITInN IlK} DAYS OF ISSUANCE OR IP <br /> WORK IS SUSPENDED FOR IS0 DAYS, <br /> <br />2A. cONTRACTOR INSTALLATION ONLY <br /> <br />Signut ute o f S u~ising Eleglri¢ia,~ <br /> <br />218. FOR OWNTiR INSTALLATIONS <br /> <br />Property Owner ~leaso pdtJO <br />Mailing Address [ Phone <br />City/State/Zip <br /> <br />:3. PLAN REVIBW SttCTION <br /> <br />IMarion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Sect t n 58 and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC l.q-.?4 19~94 <br /> <br />4_ FEll SCHHDULE (Cmnplete and emer total in A 1 below} <br /> <br /> Residential <br /> pm' <br /> Unit <br /> <br />10ft,) sq. ft. or leas $8.5,00 4 <br />Lixnit~d Energy $20.00 ...... <br /> <br /> 20I amps tO 400 amp~ <br /> <br /> ~1 a~pa to 1000 <br /> <br /> 201 amps to ~0 amps <br /> <br /> Over 600 amps or 10~ vol~ <br /> <br />D, Braaoh Circuits <br /> <br /> a) ~ fCC for brach <br /> ~c~se of ~er fee <br /> <br /> b) ~le fee for branch circuits <br /> <br />~, Mig~llan~us (~vicO ~ F~ N~ Include) <br /> ~h pump or i~igalion <br /> ~¢h si~ or outline light~ <br /> <br /> O~r th~ allowable <br /> <br />O. Min~ Installation Labels <br /> Pack of 10 labels ~ $5.~ tach <br /> (~l d ~ly to ~cclrica l contractocO <br />H. Oth~ <br /> (~ required by ~ildi~ O~doO <br /> <br />$50.00 2 <br />$60.00 ___2 <br />$100D0 ,2 <br />$130.00 __2 <br />$300,00 __2 <br />$40.00 __2 <br /> <br />$35,00 <br />,$40.00 <br />$80,00 <br /> <br />$ 2.00 <br /> <br />$ 2.00 <br /> <br />$40,00 2 <br /> <br />$40.00 ,,, 2 <br /> <br />$35.00 __ <br /> <br />$50.00 <br /> <br /> ~, ll, x $.I~ =_.__ <br /># of Labels. . NIC__ <br /> <br />5. FEES <br /> Al, Enter total of f~¢s fwm Sec. #4 <br /> A2. Add 5% sumharge (,05 x Al) <br /> Subtotal <br /> <br /> B, Enter 25% of line A l for Plan Review <br /> (See, 3), if required <br /> C. Inve~tisation Fee (if required) <br /> D, Reinspeetlon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. ,, <br /> <br /> <br />