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Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE * Room 132 <br /> Salem, OR 97301 <br /> <br />:24 Hr Inspection Lh~e: 588-7904 <br />Office: 588-5147 8:00a.m.-4:30p.m. <br />FAX: 58$-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />~R~TS A~ NON-T~NS~LE AND ~Pi~ IF WO~ I~ N~ <br />3TAR~ ~HIN I ~ DAYS OF ISSUAN~ OR IF <br /> WO~ IS $USPEND~ FOR 180 DAY~. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />$ignaturo Of S'api:~ising Electrleian <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 />I specifications with this application. <br /> <br />MC l $., ~4 12/94 <br /> <br /> {S-./S2h2o <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. P~B SCH]SDL1LH (Complete and enter tol~l in Al below) <br /> <br />~vi~ Include: lten~ ~o~t (each) Sum <br />~eh addltioaal 5~ sq. fi. <br /> <br />Limited Energy $20.~ 1 <br />~h Manofa~tu~ Hme or Modular <br /> <br /> 200 amps or less $50.00 -- 2 <br /> 201 amps to 400 amps $fi0.00 2 <br /> 401 amp~ to 6(10 amps StiX)IlO -- 2 <br /> fl01 amp* to I000 amps ~ $130.00 , 2 <br /> Ower 1000 amps or volts ~ $300.00 , 2 <br /> Remnneet only $40.00 -- 2 <br /> <br />C. Tompccary ~viOoa/P~eders <br />in~tall/*tion, Alterstlon, ~ Relocation <br />200 amps or less $35,00 2 <br />201 amp* to 400 amps i40,00 2 <br />401 alnp* to 600 amps $80,00 -- 2 <br />Ov,r 600 amps or I000 volts <br /> <br /> a) The fee for Draa0h ¢~uits ~6,1h <br /> <br />E, Mi~ellanooua (Servi~ ~' Feeder N~ lnclud~t) <br /> gaeh~l,uJJOg or i~igatbn elsie ~ ~,00 -- 2 <br /> <br />8~nfl elreuit(s) or a limi~d en¢r~ <br />panel, alteration or extemion ~ ~.~ 2 <br />F, ~¢h additional Ingp~tlon <br />Over the allowabl* in any of ~e <br />a~ve, per ~sp6¢tion $35,00 ~ <br />O- Min~ ln~al~tloa Labels <br />PaCk of 10 l~el~ ~ $5.~ tach $50,~ <br />(sMd oo1~ to el~Irlcal ~o~r~tors) <br /> <br /> (~ rvquired by Boildi~ Ol~*i~O <br /> Dwell~g Pe~it ~bel ff of ~bels. ~ <br /> <br />FEES <br />A 1, F~ler total of f¢,~ e S from Se~, #4 $.__ <br />AZ, Add$% sur,:halpg~ (.05 x Al) <br /> $~blotal $.~ <br /> <br /> B, ~lter25% oflln0 Al for Plan Review <br /> (~. 3), if mquimd $.~ <br /> C, Investigation Fe~ (ifrequit~) $ <br /> <br /> ~T~ ~0~ DUE <br /> <br /> <br />