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FOR CITY VALIDATION <br />Received by:, <br />Dat~: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNrFY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Insp~lon Line 373-4427 <br />Office: Phone ~8-~147 8:00am - 4:30pm <br />FAX: 58S.'/948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete ail~,Se~, tions, I through_ <br /> <br />PERMITS ARE NON-TRANSFER. ABLE AND EXPIRE 1F WORK IS NOT <br />STARTEZ) WITHIN 180 DA YS OF I$SUA/~CE OR IF <br /> WORK I$ SUSPENDED FOg. 180 DAYS. <br /> <br /> CONTRACTOR II~TALLATION ONLY <br />F'~mcsic°a~m~CHERRY CITY I ~x"'~3997609 <br /> <br />MailingAddmas ELECTRIC POB 12668', Salem <br /> <br />FOR OWNER ]Ni~TALLATIONS <br /> <br /> Mailing Address <br /> <br /> City/Stat~'.ip <br /> <br /> Owner's Signature: <br /> <br />3. PLANRHVIEW 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 />PERMIT NO: <br /> <br />Date: 2: <br /> <br />Issued by: ~ <br /> <br />C. Temporary ;~vleea/Feede~s <br /> lnsmllatlon. Alteeatle~ or Relocation <br /> 200 an~ or le~ <br /> 201 empe to 400 amFe <br /> <br /> Ov~ 600 amp~ or 1000 volts <br /> <br />D. Branch Circuits <br /> New, Alterations, or Extension Pe~ Panel <br /> a) The fee f~ branch circuits with <br /> <br /> Ene, h branch circuit <br /> <br />$35.00 2 <br />$40.f10 2 <br />S80.00 2 <br /> <br />2.OO <br /> <br />b) The fee for beanch ci~uim without <br />E~ch additional branch circuit <br /> <br />$35.00 <br />$ 2~00 <br /> <br />E. Mieeelleneoo, (service or Feeder Nat Included) <br />Each pump or in~ation ckcle .... $40.00 2 <br />Each sign or omllne li~atln~ $40.00 2 <br />Signal ¢i~dit(a) ora limlted ~le~,y <br />pan~l, alteration or extemlaa $40.00 2 <br />F. Hach additional In~ <br />Over the allowable i~ any ote <br />a~ove, pec Inspection $35.00 <br />O. Mina: Installation Labebs <br />Pack of 10 lsbdis ~ $5.00 each $50.00 <br />(sold only to e~l <br />H. Other <br />(As reqoired by Bud~t~ O~cltl) <br /> Atamra Dwelling Ele~trJcdi Fee __~q. <br /> Dwalling Permit Label # of Labels N/C <br /> <br />5. FEES <br /> Al. Enter ~otal of fees from See. ~4 <br /> A?.. Add 5% surcharge (.05 x Al) <br /> <br />B. End. er 25% of tine At Cot l~.a, Review <br /> (Sec. 3), ii'required <br />C. Investigation Fee (ifze, quired) <br />D. Re~pec(~on Fee <br /> <br /> TOTAL AMOUNT DUIZ <br /> Receipt No ........ <br /> <br />MC 15-3d t/96 <br /> <br /> <br />