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[FOR CITY VALIDATION] <br />eceived By: <br />ate: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br /> Off.ice: phone 588-5147 $:00am - 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> "°NEl I I XI©I? <br /> DC~p~EScST~SoTRN~ET/ ~) 0 (~ ~ --~ ~ ~ <br /> <br /> P~ ~ NON-~S~LE ~ EXP~ IF WORK IS Nm <br /> / <br /> AYS ov OR <br /> J <br /> WO~ IS SUS~ ~R 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br />Mailing Address City <br /> <br />2B. FOR OWNER INSTALLATIONS <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 />PERIvlIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4, FEE SCHEDULE (Complete and enter total in Al below) <br />A. Residential Per Unit Number of Inspections per permit allowed <br /> 1 <br /> Service Included: Items Cost (each) Sum <br /> 1000 ~l fl. o r less $85.00 4 <br /> Each additional 500 sq. fl. <br /> or periiou thereof $15.00 <br /> Limited Energy ~r~ $20,00 ~2 <br /> MEat~u iMa ra~U~fv ea~tliUn gr eds eH; it; or I $40.00 <br /> <br />B, Services or Feeders (Does ~ include branch circuits, see section D) <br /> Installation, Alter ion. or Re tio <br /> <br /> 201 ampsto OOamps{'}.,nnxO~¢~ ] $60.00 I~R--2- <br /> 401 amps to 600 amps V"~ ~ S100.00 2 <br /> 601 ~unps to 1000 amps --'v $130.00 2 <br /> Over I~0 amps or volts $300.00 __ 2 <br /> Reconnecl only $40.00 2 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alterations, or Relocation <br />200 amps or less $35.00 __ 2 <br /> <br /> a) The fee for branch cLrcuits wi~ ~ ~' <br /> ourch~xe of ~erv~ce or feeder fee ~'~ ~ <br /> <br />5. FEES <br /> Al. Enler total of fees from Sec. g4 <br /> <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if requited <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 7/97 <br /> <br /> <br />