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FOR CIT~ VALIDATION] <br />Received by: I <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 Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br />Date: .~ <br />Issued by: ~_ ~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORI~ <br /> STAR'I~D wrrHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />EOHTRACTOR INSTALLATIOF <br /> <br />Phone~ Fax~ <br /> <br />Property Owner Phone~ <br /> <br />Electrician <br /> <br />Phone~q <br /> <br />3. PLAN RE~iISW 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 />4. FEE SCHEDULE (Complete and enter total in A1 below) <br />A. Re~idontlal Pea Unit Number oflnspectinna pe~ p~rmit allowed -~ <br /> ~a'vine Included: Items Cost (each) S <br /> ~mt <br />1000 sq, ii. or less $85.00 4 <br />Each additional 500 sq. fL <br /> er poaion thereof $15.00 <br />Limited Energy $20.00 <br />Each Manufactured Home or Modular <br /> Dwellin~ Feeder [ $40.00 2 <br /> <br />$35.~ <br />$40.~ <br />$~.~ <br /> <br /> Over 600 amps or 1000 volts <br /> see "B" above ~"',J <br />D. Branch Circuit._ <br /> <br /> Ea;:hbrancheircuitx0...~~.~.~ (* ~O(__._~) $2.00 <br /> Fimt brmeh ci~uit ~ $35.~ <br /> ~ch addi~onal b~ch c~t $ 2.~ <br /> <br /> ~ch pump or ~gaion circle ~.~ <br /> ~eh si~ or outline li~t~g ~.~ <br /> Sign~ ci~uit(s) or a I~ited <br /> <br /> Over the allowable in any of ~e <br /> <br /> ~ek of 10 l~els ~ $5.~ ~ch $50.~ <br /> (sold o~y to el~trica l co.factors) <br /> <br /> (~ required by ~ildiag OfficiaO <br /> Au~a Dwelli~ El~cal F~ ~sq. fi. x $.068 <br /> ~elling Pe~it ~bel <br /> <br />5. FEES <br />A 1. Enter total of fees from Sec. #4 $__ <br />A2. Add 5% surcharge (.05 x Al) $__ <br /> Subtotal $.__ <br /> <br /> B. Emer 25% of line Al for Plan Review <br /> (Sec, 3), if required $.__ <br /> C. Investigation Fee (if reqdired) $.__ <br /> D. Reinspection Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE $ ~TC'~ <br /> Receipt <br /> No. <br /> <br /> <br />