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FOR CITY VALIDATION Received by: 1. LOCATION OF INSTALLATION MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 PERMIT NO: Salem, OR 97301 Date: ~ Hr Insl~ction Line: 588-7904 Date: ~ I~8-~[47 8:00am -430pm. --- ELE~RICAL PERMIT APPLICATIO~ ~secomplete~l S~ttons, 1through 5 I,'~, ~ 0 ~fi~"(Cmpiot~andent~Btal~Al~low, ~10~ ~[~ Rmidenti.l P~ Unit Nmnb~rofln,p~tio.s p~it alBwed ~ ~UIL~t~:C i~' )~,~rv~,i~].~in~: ],~.~ ~,(..~) S.m, ~ ~dditio.al 5~ ~q, fl. Directions PERM1TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR ! 80 DAYS. 2A. CONTRACTOR INSTALLATION ONLY 2B. FOR OWNER INSTALLATIONS PmperbJ Owner (please print) Mailing Address } Phone City/StawdZip Owner's Signature: 3. PLANRBVIBW SECTIOIq 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 12/94 $15.00 Limited Energy $20.00 Each Manuthetured Home or Modular Dwelling Service or Feeder $40.00 -- B. Servie~ or Fc~ders (Does not include branch circuits, see ae~tinn D) Installation, Ak~ation or Roloe~tioa 200 amps or le~ [ $50.00 2 201 amps to 400 amps $60.00 2 401 amps to 600 amps $100.00 2 601 amps to 1000 stops $130.00 2 Over 1000 amps or volts $3~0,00 2 Reconnect only $40.00 -- 2 C. Temporary ~ervice~Feed~s Installation, Alt~r etlon, or Reloeatinn 200 amps or less $35,00 2 201 amps to 400 amps $40.00 -- 2 401 amps to 600 amps $80.00 2 Over 600 amps or 1000 volts D. Branch Circuits New, Alt~ations, of Bxteaalon p~ Panel a) The fee for branch circuits ~ g!!~hase of service of feeder fee Each branc~ circuit $ 2.00 b) l~e fcc for branch circuits without purchase of servlcc or feeder lee First branch cimuit Each additional branch ¢ir¢[fit $35.~ $2.~ E. Mi~ellaneous (Service, or Fe~der Not Included) Each pump or irrigation circle $40.00 2 Each si~ or outline lighting $40.00 2 Signal circuit(s) or a limited energy tnmcl, alta, ation or exletlalon $40.00 2 F. Bach additional inspection Over the allowable in any of the above, per Inspection $35.00 -- ~. Minor Installation Labels Pack of 10 labels @ $5.00 each $50.00 tsold only to eloctricM contractors) H. Other (As required by Building OITtcial) ^utora Dwelling EleetrieaIFae sq. tZ z$.06 = -- Dwelling permit Label # of Labeh NIC 5. FBES Al. Enter total of fe~s from Sec. #4 A2. Add5% surcharge (.05 x Al) $ Subtotal $ ~-~'~-~ B. Enter 25% of line A I for Plan Reviow (See. 3), if required $. ~v / C. Investigation Fee (if requited) $ D. Reinspection Fee ($25.00) $ TOTn~ mouvr mm s Receipt No.