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FOR CITY VALIDATION <br />R iv a <br />Date:. <br /> <br /> MARION COUNTY <br />i BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br /> 24 hr. InsPeCtion Line 373-4427 <br />Offie. e~ Phone 588-S147 8:00am ~ 4:30pm <br />FAX: $88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~ections, I through <br /> <br />1. LOCATION OF I~STALLATION <br /> <br /> P~ ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTE~ ~ 180 DAYS OF ISSUAN(~g OR IF <br /> WORK tS SUSPENDED FOP. 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> ..Z <br /> <br />Supcr vlsor's License No. ..~ ~ ~---~ ~'~ <br /> <br />2B. FOR OWN-I~ INSTALLATIONS <br /> <br />l~ope~ty Ovngr <br />Mailing Address I <br /> <br />City/State,Zip <br /> <br />Owner's Sigm~ure: <br /> <br />3. PLAIq RIg'v'IRW SBC'I'ION <br /> <br />IMadun County does not re. quke a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and subniit two (2) sets of plans and <br /> specifications with this application. <br /> <br />Dato: <br /> <br />Issued by: <br /> <br />4. ~]~ SC]~DU-L~ (~omplct¢ and ~ total ~ A 1 below) <br /> <br />~ R~d~t~l ~ Unit Nm~r of~ p~ ~it hi.wed ~ <br />~in~: lt~ C~t(~h) S~ I <br />1~ ~. ~ or ~ $~5.~ 4 <br />~ch a~n~ ~ ~. f~ <br /> <br />~ M~fac~ H~¢ or M~I~ <br /> <br />200 aml~ or le~ <br />201 amp~ to 400 am[~ <br />401 amps to goo amps <br />601 am~ to 1000 amps <br />Over 10OO amp~ or volts <br /> <br />201 amps to 400 aml~ <br /> <br />~) The fe~ fe~ branch ck'cui~s <br /> <br />Firs[ branch ¢i~cult <br />Each additional branch <br /> <br />$60.OO 2 <br />$100.00 2 <br />$130.00 2 <br />:$300.OO 2 <br />$40.00 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />SgO.O0 2 <br /> <br />$ ZOO <br /> <br />$35.OO <br />$2.OO <br /> <br />$40.00 2 <br />$'IO.OO 2 <br /> <br />$40.OO 2 <br /> <br />$35.00 -- <br />$50.00 <br /> <br /> 'sq. fl. x $.068 = <br /># Of LaIgh _ NIC <br /> <br />A2. Add 5% suroharga (.05 x Al) <br /> <br />B. ~% ~eAl forPl~Review <br /> <br /> ~T~ ~O~ D~ <br />R~elpt <br /> <br /> <br />