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FOR CITY VALIDATION <br />Received by: <br />Date: p t e: 7904 <br /> <br />ELECTRICAL PERMIT APPLICATION ,,"ILL { 4 1991 <br />Please complete all Sections, I through ~a~fON COUNT <br /> <br />L LOeATZON OF ~S~A~ZO~ BUILDING INSPEC] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 28.5 Church St NE · ROOln 132 <br /> PERMIT NO: <br /> Salem, OR 97301 <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WOR~ IS NeT <br /> STA RT~D WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WOP, J( IS SUSPI~NDED FOR IS0 DAYS. <br /> <br />2A. COINITRACTOR iNSTALLATION ONLY <br /> <br />2B. FOR OWNBR iNSTALLATIONS <br /> <br />Prope~y Owilef ~lcase £cie0 <br /> <br /> Mailing Addceas j Phone <br /> City/State/Zip <br /> <br /> 3. PLANRRVIEw SECTION <br /> <br /> Markm County dries not require a plan review. <br /> We will provide plan review service if you complete <br /> Settlor 5B and sublnit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-.t4 IZ/94 <br /> <br />Date: <br /> <br />issued by: <br /> <br />t 4. FEE SCHI~DULB (Complete and enter total ill Al below) · <br />; Number of Inspections p~ permit allowed <br />[~R~idontia{ Pe¢ Ullit ~ <br /> 10~ aq, a. or less $85.(~) 4 <br /> <br /> 200 amps or less $50,00 --.. 2 <br /> 201 alnps to 400 amps $60.00 2 <br /> 401 amps to 600 amps SI(F,),00 -- <br /> 601 amps to 1000 amps $130.00 <br /> Over 1000 amps ot rolls $300.00 2 <br /> Reconnect only $40,00 2 <br /> <br />C. Temporary ,%rvi~a/Pe~tets <br /> <br /> ~00 amps or less $35,00 2 <br /> 201 amps to 400 amps $40.00 -- 2 <br /> 401 amps to 600 amp~; $80.00 2 <br /> Over 600 amps of 1000 volts <br /> <br /> a) The fee for b~a~ch circuits with <br /> l~ach bralxeh ¢irguit $ 2.00 <br /> b) %a t~e for branch circuits ~ <br /> Pirst bt~ch circuit $35,00 <br /> <br /> (A~ reqoiced by Buil~iitLe <br /> <br /> __ eq. IL x $.06 = __ <br />Dwelling Permit Label <br /> <br />5, FEES <br />A I, Enter total of fees from See, #4 <br />A2. Add 5% surcharge $05 x Al) $., <br /> Subtotal $.__ <br /> <br /> B, Enter 25% of ]ill~ A 1 for Plan R~vi~w <br /> (Sec, 3), if ~qtdred $.~ <br /> C, Investigation Fee (if~qui~d) $.~ <br /> D. Reinspection Fee ($25,~) $. <br /> <br /> TOT~ ~ou~ <br /> Receipt No. ~ <br /> <br /> <br />