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FOR CITY VALIDATION <br />Received <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 />ELECTRICAL PERMIT APPLICATION <br />Please complete gl Sections, I through 5 <br /> <br />24 Ht lflap~tion Lia~. 588-7904 <br />Offlc.~: 5884147 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> I <br /> <br />LOCATION OF INSTALLATION <br /> <br />i'-J" m i d (Y m:..¢, ' <br /> <br />[PER~T$ A~ NON-~A~S~B~ AND ~PI~ iF WORK I$ ~OT ] <br />START~ ~I~ 1 ~ DAYS OF I$$UAN~ OR IF <br /> WO~ 18 ~USP~DED ~OR 180 DAYS, <br /> <br /> ~_ CO~RACTOR ~T~LATIO~ O~Y <br /> <br />~,B. FOR o~qlq~ER INSTALLATIONS <br /> <br />City/StntedZip <br /> <br />Date: <br /> <br />3. PLANREVIBW 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 /> FEE SCH]~DUL]~ (Complete and entel <br /> <br /> R~denfial <br /> Unit <br /> <br />~ adfihlonfl 5~ sq. k <br /> <br />MrY LS-J4 1~ <br /> <br /> 200 amps or less <br /> 201 amps to 400 al~it),9 <br /> 401 amps to 600 amp <br /> Over riO0 amps or 1000 volts <br /> <br /> I <br />£- Ml~ell$~ (~rvie, o ~r p~dee Net hck~ka) <br /> <br /> (,4* t~q~irod by Building <br /> <br />A 1, ~dcr total of £eoa fIDIII S~.//4 <br />A2, Add 5% sumhatge (.05 x Al) <br /> <br />$50.00 __ 2 <br />$60,00 __ 2 <br />$I00.00 ..... 2 <br />$130,00 __ 2 <br />$300,00 ....... 2 <br />$40,00 __ 2 <br /> <br />$35.00 .2 <br />$40.00 ..... 2 <br /> <br />$ 2,00 __ <br /> <br /> ,:%¢ <br />$ 2,(XI <br /> <br />$40,00 <br />$40,00 <br /> <br /> $35.00 <br /> $50.0° <br /> <br />~1, ii, x$.06 = <br /> <br />Subtotal <br /> <br />B, Enter 25% of line A t for Plan Review <br /> (Sec. 3), i£ requlr*d <br />O, lnwstigulion Fee (i£requir~d) <br />D, Reimpection F~e ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No, __ <br /> <br />$ t, 'IT> <br />$ <br /> <br /> <br />