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FOR CITY VALIDATION' <br />Received by: <br />Date: <br /> <br />MARION COUNTY BIJILDING INSPECTION <br /> COMMUNITY DI~VELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inafmetion Line: 588-7904 <br />Office: 5B$~514.7 8:00a.m.-4:Snp.m- <br />FAX: 588-794S <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />LOCATION OF INSTALLATION <br /> <br /> PERMITS A RE NON-TRANSFERABLE AND IEXPIRE IF WORK IS NOT <br /> STARTED Vv'I'I'HI N 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />Sul}~cvieor's License No. Phone ...... , <br /> <br /> 2B. FOR OWRF22; INSTALLATIONS <br /> <br /> Pmpeay Owner Od~ase print) '~--, '~:~.~ ~ .... <br />................ ~ ,~,~,, : <br /> <br />3. PLAH REVIEW 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 aDplicatioa, <br /> <br />&lC' 15-,t4 12~4 <br /> <br />"1 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCH~DUL~ (Cc~nplet¢ and enter total ia A l helow) <br /> <br /> per <br /> IJnh <br /> <br />[000 sq, fl. or le~a ~ $85.(~) .... 4 <br />~;h additional 3~) sq, fl, <br /> <br />Limited ~ncrgy <br /> <br />B, S~vleos ~ F~s (~s not indude branch clmuits, see section D) <br /> <br /> 200 amps or lean r $50,00 ,,, 2 <br /> 201 amps to400 amps $60,00 __2 <br /> 401 amps to 600 amps $100.00 --. 2 <br /> 601 amps to 1000 amps $130,00 ......... 2 <br /> Over 10O0 aeps or volta $300,00 -- 2 <br /> Reconnect only 540.00 ..... 2 <br /> <br />C, Tempr~ary Serv[el~t/F~t~-~ <br /> <br /> 200 am s or less $35.00 2 <br /> 201 amps to 400 at,ps $40.00 .... 2 <br /> 401 am[~ lo 600 amps $80.00 2 <br /> Over 600 ~unps or 1000 vt,Its <br /> <br />D, Branch Circuits <br />Now, Alterations, c¢ ~x~enaion Par Penel <br />a) The fee for braa¢h ¢ireuil~ v4ktt <br />la[rqha~,~ of servie~..o.f feeder fee. <br />Each branch eircult $ 2,00 -- <br /> <br /> b) The fee for branch circuits wilh93~l <br /> <br /> (A~ required by Buildi~E O~cial) <br /> <br />sq. ~l, z $.06 =__ <br /> <br />Dwelling Permit Label # of Labels ~ILC_. <br /> <br />FEES <br />Al, E~ter total of fees fmrn Sec. #4 <br />A2, Add 5% sumhars~ 60,5 x Al) <br /> Subtotal <br /> <br />B. Ent~ 25% of line A 1 l~f Plan Review <br /> (Sec. 3), if ~qui~d <br />C. Investigation Fee (if~quired) <br />D. Reimp¢¢tion Fee ($25,~) <br /> <br /> <br />