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FOR CITY VALIDATION <br />Receiwd bY: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPBCTION <br />COMMUNITY D~.VELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspee. tion Line¢ 588-7904 <br />Off'we: $88-5147 8:00a.m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all 8~otlons, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />2A. CONrKACTOR INSTALLATION ONLY <br /> <br />flailing Add,ess <br /> <br />No. <br /> <br />Contractor's Board Reg. NO, <br /> <br />2B. FOR OWNBR IN8TALLATION8 <br /> ~e ~llf¢ <br /> <br />3. PLAN REVIBW SBCTION <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 15-34 1~ <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />I~ued by: <br /> <br />4. PliE 8CHBDULB (Complel~ and entea- total in Al below) <br /> Number of Inspeofions p~ psnnit allowed ~ <br />A. R~id~tiM Per U~,it i~~~ <br />Service Included: <br /> <br />Each eddltlona[ 500 sq. ft. <br /> or portion thereof <br />Limited Energy ~ $20.00 1 <br />Each Manufaotmzd Home or Modular <br /> Dwelling Szrvice or Fe~der $40.00 2 <br /> <br />B. 8~rvie~s or F~deea (Does not incind~ branch ¢ir~'uils, s~ section D) , <br /> <br /> 200 amps or le~ ~ $30.00''-~ ~'~ 2 <br /> 201 amps to 400 amps $60.00 2 <br /> 401 amps to ~00 amps $100.00 2 <br /> 601 ampa to 1000 amps $130.00 2 <br /> Over 1000 amps or volts $300.00 - 2 <br /> Reconnect only $401)O 2 <br /> <br />C. Temporary 8ervin~aF~der~ <br />lastallafion, Alteratioa, ~ Rdooation <br />200 amps or le.~ $35.00 2 <br /> <br />401 amps to 600 amps $80.00 2 <br />Over 600 amps or 1000 volts <br />see "B" above <br />D. Branch Circuita <br />lq~w, Alt ~ratlons, m' B~lslon P~ Panel <br />a) The fee for branch cir~ults ~ <br /> <br /> Each bran~ eh~uit . $ 2.00 <br /> b) The fee fo~ branch ei~uits without <br /> <br /> First branch circuit $35.00 ~ <br /> Each ed&donal branch ~ireuit $ 2.00 <br /> <br />R. Mbodlsneous (Se~vle~ F~d~ Not ln~d~) <br />~ pump or ~gation c~le ~,~ ..... 2 <br />~ ai~ or outl~o li~fing ~.~ <br />S~ c~uit(s) ~ e I~t~ ~ <br />~el, ~t~ or extemi~ ~.~ 2 <br />F. Ea~ a~Rio~l <br />~et t~ allowab~ iu ~ of ~ <br /> <br /> Pack of 10 la~ ~ $5,~ ~ch $~.~ <br /> <br /> (~ ~dred by ~ildi~ 0~1) <br /> <br />FEES <br />A 1. Fmter total of foes from Se~.//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. lnveatigation Fee (if r~quired) $.__ <br />D. Relmpeetion Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE S <br />Receipt No. <br /> <br /> <br />