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FOR CITY VALIDATIONI Received by:.. Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 24 hr. Inspection Line 373-4427 Office: Phone 588-5147 8:00am - 4:30pm FAX: 588-7948 ELECTRICAL PERMIT APPLICATION I Please complete all Sections, I through 5 I 1. LOCATION OF INSTALLATION PERMITS ARE NON-TRANSFERABLE AND E~PIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUAHCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY Address ~0~C~7 -- Contractors License No. C°ntract°r's B°ard Re' N°' '~ ~/'t/-~ I $°b N°' ~'" 2B, FOR OWNIIR INSTALLATIONS l~op~rly Owner (please print) Mailing Addreas I Phone City/State/Zip Owner's Signature: 3. PLAN REVIEW SBCTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MC 15-34 1/96 Date: Issued by: 4. i~EE SCHEDUL~ (Complete and enter total in A 1 below) A. R~id~tial Per Unit Nmnber ofInspsotions p~r p~rmit aliowed --~ ~erviee Included: ltenm Co~t (each) S 10O0 sq. fl. of leas $85.00 4 Each additional 500 sq. ft. or portion thereof $15.00 Limited Energy $20.00 1 Each Manufactured Home or Modular Dwelling Sen, ica or Feed~ $40.00 2 B. ~,t vie~ o~ F~l~s (Do~s not in¢lud~ branch eireuit*, se~ s~tinn D) In~allation, Alt~ation or Relocation 200 amps or 1~ 201 amps to 400 amps 401 amps to 600 stops 601 amps to 1000 amps Over 1000 amps or voll~ Reconnect only C. Tomporary Setvioea/Feed~ra sso.oo $60.0O 2 $100.00 2 $130.00 2 $3O0.00 2 $40.00 2 $35.~ 2 $~.~ 2 $ 2.00 $35.00 $ 2.00 $40.00 2 $40.00 2 $35.0O $5O.OO sq. ft. x $.068 =__ # 0f Labels lq/C 5. FEES A 1. Enter total of fcea from Sec.//4 A2. Add 5% surcharg~ (.05 x Al) 8ubt~al B. Enter 25% of line Al for Plan Review (Sec. 3), if required C. Investigation Fee (if required) D. Reinspection Fee ($25.0O) TOTAL AMOUNT DUE Receipt No.