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FOR CITY VALIDATION <br />Received 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 Insp~tion Line: 588-7904 <br />Office: $88-5147 8:OOa.m.-4:3Op.m. <br />F~: 588-7948 <br /> <br />Date: <br /> <br />Issued by; <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1_ LOCATION OF INSTALLATION <br /> <br />STARTED WTTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUIPI~NDED FOR 180 DAYS. ~ <br /> <br />CONTRACTOR LNSTALLATION ONLY <br /> <br />Contractor's License No. <br /> <br />q5337 [,,ohio. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (pleas~ prinO <br /> <br />Mailiog Add.ss ~ Phone <br /> <br /> City/State/Zip <br /> <br /> 3. PLANREVlEW SECTION <br /> <br /> Marion County doeg not require a plan review, <br /> We will provide plan review service if you complete <br /> Section 5B and gubmit two (2) sets of plans and <br /> gpecifications with this application, <br /> <br />MC 1.5-34 12./94 <br /> <br />4, FEE SCNI~DULE (Complete and enter total in Al below) <br /> <br /> ~vlcolnclud~: lte~ Cost (each) Suu <br /> <br /> or ~ion flmraof $15,~ <br />Limited Energy $20,~ ~1 <br /> <br /> Dwelling Se~iee or Feeder $4(),~ 2 <br /> <br /> ~ 1 amps to ~0 am~ $~.00 <br /> ~1 amps to ~0 am~ $1~,00 <br /> ~1 amp* to 1000 amps $130.00 2 <br /> <br /> Remnnect only $~.00 2 <br /> <br /> 200 am~ or Ie~ $35.00 2 <br /> 201 amps lo ~0 amps $~.~ 2 <br /> 401 am~ to ~0 amps $80.00 <br /> Over 600 ~pa or 10~ vol~ <br /> <br />D. Bran~ Circuits <br /> <br /> a) ~* fee l~ brach ¢imui~ ~ <br /> <br />b) The lee for branch circuits <br /> ~urchase of service or fe~d.ec.,f~ <br />First b~eh circuit <br />Each additional brtm~h circuit <br /> <br />E, Mi~ellanoous (~ervleo or I~l~r Ne~ Included) <br /> ~ch pump or i~igat/on clgle <br /> <br /> Signal eireuit¢) or a limited en~gy <br /> <br />F. Each additional Insp~tion <br /> Over the allowab]* in ally of the <br /> <br />O. Min~ Installation Label$ <br /> Pack of 10 labels <br /> (~old o~ly <br /> <br /> (~ required by Building O~eJaD <br /> <br />$ ZOO ---- <br /> <br />$35.00 <br />$ 2.00 ~ <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35,00 ......... <br /> <br />$50,00 <br /> <br /> sq. tL x $.06 <br />g of Labels, <br /> <br />PEEt <br />Al, l~nter total of f~es from Sec. #4 <br />A2, Add 5% surcharge (.05 x Al) <br /> 8t~btotal <br /> <br />B. EiIter 25% of lin~ A 1 for Plan Review <br /> (gcc, 3), if required <br />C. lnwatigafion F~ (ifrequln:d) <br />D, Rcimpcction Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />