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FOR CITY VALIDATION[ <br />R~eived by: <br />Date: <br /> <br />MARION COLTNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr In~)ectlon L~e: 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-75'48 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />P~s A~ NON-~NS~B~ AND ~PI~ IF WO~ I~ N~ <br />STARED ~IN 1 ~ DAYS O~ I~SUAN~ OR IF <br /> WORK IS SU5PEND~ FOR 1~ DAYS, <br /> <br />2A.. CONTRACTOR INSTALLATION ONLY <br /> <br />Phone <br /> <br />3. PLAN REVIEW SECTION <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 />MC L5.$4 iZa)4 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. I~I~E SCHI~DLrI~t (Complete and enter total in Al below) <br /> Ntunber or [nspeOtiona per ~tlnit allowed <br />A- <br /> <br /> / <br />200 amps or less t $$q.00 2 <br />201 nrnp~ to 400 am~ $60.00 2 <br />~1 ampa to ~0 um~ $1~,00 2 <br />~1 ampa m 1000 ~pa $1~,00 2 <br /> <br />Reconnect only $~,00 2 <br /> <br />C. TempOrary Servi~otF~lors <br />Installation. Alteration, or Roloe. ation <br />200 amp~ or less $35.~ <br />201 amps m ~0 amps $40.00 <br /> <br /> / <br /> <br />b) The t~e for branch circuits <br /> l/IUZflhg~of a er~i¢~aLfe~0.der <br /> <br />E~eh additional b~meh ¢ir*uh <br /> <br />$35,00 <br />$ 2.00 -- <br /> <br />~ch pump or i~igafion cimle <br />~eh si~ or outline li$1tillg <br />Signal ¢imuit(s) or a liluited energy <br /> <br />(~ required by Buildi~ O~claO <br /> <br />$40.00 __ 2 <br />$40.00 __ 2 <br /> <br />$40.00 ,2 <br /> <br />$35,00 -- <br />$50.00 <br /> <br /># of Labels <br /> <br />5. FEES Al, [$nter Iotal of £eea from Soc. #4 <br /> A2, Add 3% surcharge (,05 x Al) <br /> <br />Subtotal <br /> <br />B, Enter 25% of line A I tbr Plan Review <br /> (See, 3), if required <br />C, Investigation Fee (if~qulred) <br />D. Reinspeetion Fee ($25,0(}) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, ,.. <br /> <br /> <br />