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IFOR CITY VALIDATIONI <br /> Recoivodby: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPRCTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> P~S A~ NON-~NS~MB~ AND ~1~ IF WO~ l$ NOT <br /> ST~ ~ 1~ DAYS OF ISSUAN~ OR IF <br /> WO~ 1S SUS~DED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> [ <br />Con~ac.r's ~ ~ No. ~V J l~ No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />24 hr. Inspection Line 373-442? <br />ofaee: Phone 588-5147 8:00am -4:30pm <br />FAX: 588-794S Issued by: <br /> <br /> 4, File SCHEDULE (Complele and enter tolal in A l below) <br /> Number of Inspeelion! <br /> permit <br /> aliowed <br /> <br /> Service Included: l[ema Ce~t (each) Sum/ <br /> 10OO sq. fL or leg $8J.00 <br /> 4 <br /> Each additional $00 sq. rt. <br /> or porlion thereof $15.~0 <br /> Limited Energy $20.00 1 <br /> <br /> Dwelling Service or Feeder $40.00 2 <br /> <br /> 200 amps or less g $50.00 ~ 2 <br /> 201 amps to 400 amps $60.00 2 <br /> <br /> 601 aml~ to I0~0 amps $130.00 2 <br /> Over 1000 amps or volta :~00.00 . 2 <br /> Recoonect only $40.00 <br /> <br /> C. Temperary 8erviee~Feeders <br /> <br /> 200 amps or les~ $35.00 2 <br /> 201 amps to 400 amps $40.00 2 <br /> 40! amFa to 600 amps SE0.00 2 <br /> Over 600 amp~ or 1000 vol~s <br /> <br /> D. Brand~ Ckoui~a <br /> New, AltelraT~dl~ Rnten~ion Pe~ Panel - <br /> <br /> Each branch cimuit <br /> <br />Pwge~y Owner (pier.prim) <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review, <br />We will provide plan review service if you complete <br />Section SB and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-$41/96 <br /> <br />$ 2.00 <br /> <br />$35.~ <br />S2.~ <br /> <br />$40.00 2 <br />S40.00 2 <br /> <br /> 2 <br /> <br /> sq. ft. x $.068 =_ <br />//of Labels NIC <br /> <br />5. FEES <br /> A [. Enter Iolal offe~ from Sec. #4 <br /> A2. Add 5% surcharge (.05 x A l) <br /> Subtotal <br /> <br /> B. Enter 25% or line A 1 for Plan Review <br /> (Sec. 3). irrequired <br /> C. Invest[galJon Fee (il'requited) <br /> D. Reimpection Fee (525.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />