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FOR CITY VALIDATION[ <br />Received by: [ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr, Inspection Line 373-4427 <br />Office: Phone 588-fi147 8:00am - 4:30pm <br />FAX: S8S-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all ,Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job Address <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> - <br /> <br />?ropert~ Owner ~, ~//~ Pho~ <br /> <br />I/ob No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Properly Owner (please print) <br /> <br />Mailing Addrms <br /> <br />City/Staw~Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SBCTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review sen, ice if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-$4 1196 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> Nmnber of Inspections per permit allowed ~ <br />A. <br /> Re~ideotial <br /> per <br /> Unit <br /> Sucviee Included: Items Cost (each) Sum t <br /> 1000 sq. ft. or less $85.00 4 <br /> Each additional 500 sq. ft. <br /> or portion thereof $15.00 -- <br /> lfimited Energy $20.00 1 <br /> Each Manufactured Home or Modular <br /> Dwelling Survico or Feeder $40.00 2 <br /> <br />B. Services or Feeders (Does not include branch circuit~, nee section D) <br /> <br />Installation, Ahe~ation or Relocation <br />200 amps or less <br /> <br /> a) ~he fee for branch circuits ~1 <br /> <br />$60.00 2 <br />$100.00 __2 <br />$130.00 2 <br />saoo.oo 2 <br />$40.O0 2 <br /> <br />$35.00 2 <br />~.~ 2 <br />$ffi.~ 2 <br /> <br />$35.00 <br />$ 2.00 -- <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$4O.OO 2 <br /> <br />$35.00 <br /> <br />$50.00 -- <br /> <br />--Jq. fl. x $.068 = <br />#ofLabels NIC <br /> <br />5. FEES <br /> A 1. Enter total of fees from S~. g4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (See. 3), if requi~ed <br />C. Investigation Fee (if required) <br />D. Reimpection Fcc ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. --- <br /> <br /> <br />