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FOR CITY VALIDATION <br />Received by: . <br />Date: <br /> <br />MARION COUHTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> PERMIT NO: <br /> <br />Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Omce: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />City <br /> <br />PF~RMITS ARE NON,TRANSFERABLE AND [~CPIRE IF WORK IS NOT <br />STARTE~ ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~qD~ FOR 1 ~0 DAYS. <br /> <br />2A. CONTRACTOR INSTAL!,ATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Prope~y Owner (p/~soprint) <br /> <br />Mailing Address <br /> <br /> Cky/StatedZip <br /> <br /> Owner's Signature: <br /> <br /> 3. PLAN REVIBW 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 />MC 15-341/96 <br /> <br />Da~e: <br /> <br />Issued by: <br /> <br /> (Complete nnd enter total in Al below).~. <br /> Ntanbor of Inspections per permit allo~ ~ <br />A. Resid~ntinl ~ Unit ~ <br />8ervie~Ineluded: Items C~t(each) Sum I <br />1000 sq. 0. or less $85.00 4 <br />Each additional 500 sq. fl. <br /> or pot'don thereof $15.00 <br />Limited Bnex~y $20.00 1 <br />Each Manufactured Home or Modelar <br /> Dwelling Service or Feeder $40.00 -- 2 <br /> <br />B. 8etviee~ or Feed~s (Does not include Immch circuite, see s~ctinn D) <br /> <br />200 amps or less t/ $50.00,',~ ~ 2 <br />601 ampsto 1000amps $130.00 __2 <br /> <br />200 amps or less $35.00 -- 2 <br />201 amps to400 ampa MO.O0 __2 <br /> <br />Each branch circuit t/~ $ 2.00 ~'~ ~ <br />Each addilional branch circuit $ 2.00 <br /> <br />E. Mise~aneous (Servio~or Feeder Not Ir. eluded) <br /> ~ pump or ~gaUon c~le <br /> <br /> ~i~ c~uit(s) ~ a l~i~ ~ <br /> <br /> ~r ~e ~owable ~ any of ~e <br /> ~ve, ~ ~ect~n <br /> <br /> Pack of 10 l~els ~ $3,~ ~ch <br /> <br />H. ~ <br /> (~ required by ~ilding O~c~l) <br /> <br /> ~elling P~it ~ <br /> <br />$40.00 2 <br />M0.00 2 <br /> <br />$40.O0 2 <br /> <br />$35.00 -- <br /> <br /> sq. fl. x $.068 =__ <br /># Of Labels. NIC <br /> <br />5. FEE8 <br /> A 1. Enter ~olal of fees flom Sec. ~4 <br /> 3,2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter25% of line Al for plau Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (ifr~quir~d) <br /> D. Reinapeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />