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FOR CITY VALIDATION <br />Received by: <br />Date: .. <br /> <br />ELECTRICAL PERMIT APPLICATION <br />?/ease complete all Sections, I through 5 <br /> <br /> Salem. OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Office: 588-5147 g:00 a.m. - 4:30 p.ra. <br />FAX: 588-7948 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR IS0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Signamr~ °f Sul~hi"g El~tri~ian <br /> <br />2g- FOR OW~ <br /> <br />3. PLAN REVIEW $ttCTION <br /> <br />Marion Cotmty does not require a plan review. <br />We will provide plan review service if you complete <br />Sectk)n 513 and submit two (2) sets of plans and <br />specifications with this application, <br /> <br />MC/5-34 12/~4 <br /> <br />,4. Fiq~ $CHI~DUL]~ (Complete and enter total m Al below) <br /> ReoldenHal <br /> <br />Limited Energy $20.00 I <br /> <br />200 amps ot less $50,00 <br />201 amps to 400 amps $60.00 <br />401 amps to 600 amps $100.00 <br />601 amps to 1000 aml)~ $150,00 <br />Over 1000 amps or volt8 ~ $300,00 <br />R~eonn~ct only $40,00 <br /> <br /> 200 azllps or less $35,00 <br /> 201 amps to 400 amps ~ $40,00 <br /> 401 amps lo 600 a,nr~ $80.00 <br /> <br /> a) Th~ fee for branch ~ir~uita ~i~ <br /> Each branch eireult $ ZOO <br /> <br />b) 'Fha f~e for branch e~uit~ ~7~l.attl <br />p~e of serv~gc ot l~eder f~ <br /> <br /> Each additional branch cireuh $ 2,00 <br /> <br />E. Miseellanooua (S~viee ~- l%,ed~ Not Included) <br /> Each pump or traction ei~lo ~ $~.~ -,, 2 <br /> ~ch si~l or outline Iigll~ng $~,00 2 <br /> Signal ci~uit(s) et a limited energy <br /> <br /> above, per Inspection $35.00 <br /> <br /> Pack of l0 labels ~ $5.~ each $30.00 <br /> (s&d only to dldctrlcal <br /> <br /> (~ r~qtii~d by Buildi~ O~ciaD <br /> Au~taD~alli~ElactricalFe* , ~.~.x$.~ = <br /> Dwell/ag Pe~it ~bel ~ of ~la ~' <br /> <br />A I. Enter total of P~¢a from Se~, fi4 <br />A2. Add 5% su~harg¢ (.03 X Al) <br /> $_ <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (See. a), if ~qui~d $_~ <br /> <br />D. Rei~peetion ~ee ($25.~) <br /> <br /> <br />