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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 588-5147 8:00am - 4:30pm <br />FAX: ~88-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPElqDFeD FOR 1 S0 DAYS, <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> '- <br /> <br />~actor's Lic~se <br /> <br /> FOR OWNtlR INSTALLATIONS <br />P~geriy Own=r (plea~ptint) <br /> <br />Mailing Address [ Phone <br />City/S~atdZip <br />Owner's Signature: <br /> <br />3. PLANRBVIBW SECTION <br /> <br />I 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: <br /> <br />Issued by: <br /> <br />4. ~[~E SCH~DUL~ (Complete and enter total in Al below) <br /> Number of lnsgectlom p~r permit allowed --~ <br />A. <br /> p~. <br /> Unit <br />S~rvi~Inolud~t: ltar~ Coat(each) Sum I <br />1000 sq. ft. or tess $8S,00 4 <br />Each additional 500 ~1- ft. <br /> ~ 0ortion the~of $15.00 <br />Limited Energy 520.00 1 <br />Eaell Manufactured Hoist or Modular <br /> Dwelling Service et Feeder $40.00 2 <br /> <br />B. 8~-vic~ or F~edm-a (Doe~ not i~lude branch circuit, see section D) <br /> <br />200 amps or leas $5000 <br />201 amps to 400 amps $60.00 <br />401 amps to 600 amps $100.00 <br />601 smpsto 1000amps $130.00 -- <br />Over 1000 amps or volta $300.00 -- <br /> <br />200 amps or leas $35.00 <br />201 amps to 400 amps $40.00 <br />401 amps to 600 amps $80.00 <br /> <br /> s) The fee for branch cltouits ~ <br /> <br />E. Miscollanzoun (S~v|ez ~ F~d~ Net Inolud~) <br /> ~oh pump or ~gafion cimle <br /> ~ch si~ or ourse li~t~g <br /> Si~i c~uit(s) or a ~i~d <br /> panel, alt~atim or ~mim <br />P. Es& addRio~l ink,ion <br /> ~ t~ allowable in ~y of <br /> a~vq ~r ~p~tinn <br />O. M~ [n~a~f~ ~bda <br /> <br /> (~d on~ to el~ffktl co~r~c~rs) <br />H. 0~ <br /> (~ required by <br /> A~ra ~elli~ Ele~eal <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />$ 2.00 -- <br /> <br />s s. o 35. <br />$ zoo __ <br /> <br />$4O.OO :2 <br />$4O.0O 2 <br /> <br />$40.00 2 <br /> <br />N/C <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x A 1) <br /> Subtotal $.__ <br /> <br /> B. Eater 25% oflioeAl for PinnRevinw <br /> (Sec. 3), if required $.__ <br /> C. Investigation Fee (if required) $.__ <br /> D. Reimpe*tion F~e ($25.00) $.__ <br /> <br /> Receipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />