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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />BUILDING I~SPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone S88-S147 8:00am ~ 4:30pm <br />FAX 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> p.oTE.,Yo , <br /> p"oNEI I I I-I '1 I I-I I I I <br /> <br /> DIRECTIONS <br /> <br /> PROJECT DESCRIPTION <br /> <br /> PERMITS ARE NON-TRANSFERaBLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />(plec~e print) <br /> <br />IMalling Address <br /> <br />I City, Stat~, Zip <br /> <br /> Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br />A. Resldenfial Per Unk Numar °f Inspcvtlons P~ Permit all°wod1 <br /> <br />Modular Dwelling Service or Feeder ] $40.00 ~ 2 <br /> <br />Installation, Alteration or Relocation <br />200 amps or less $50.00 2 <br />201 amps to 400 amp~ $60.00 __ 2 <br />401 amps to 600 amp~ $100.00 __ 2 <br />601 amps m 1000 amps $130.00 __ 2 <br />Over 1000 amps or voltz $300.00 __ 2 <br />Reconnect only $40.60 2 <br />C. Temporarff ServiceelFeoders <br /> <br /> a) The fee for branch circuits with <br /> <br /> Signal circuit(s) or a limited energy <br /> <br /> (sold only to electrical contractors) <br /> <br /> (As required by Building Officials) <br /> <br />sq. t~ x $.068 = <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 />5. FEES <br /> <br /> /',2. Add 5% surcharge (.05 x Al) $ <br /> <br />B. Enter 25% of line A1 for plan Review <br /> (Sec. 3), if requlr~t <br />C. Investigation Fee (if required) <br />D. Retnspe~tion F~ ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DIrE <br /> <br />$ <br />$ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />