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FOR, CITY VALIDATION <br />Receiwd by; <br />Date: <br /> <br />MARION COUNTY:BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 ChumhSt NE- Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Insp~fion Lhte: 588-7904 <br />office: $88-5147 8:00a.m, -4:30p m <br />FAX: 588-7945 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete ~ll $~ations, I through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job <br /> <br />D~etiom <br /> <br />P~RMITS ARE NON-TRANSI~ERABLE AND EXPIRE IF WORK iS NOT <br />STARTED WITHIN 180 DAYS Op ISSUAN CE OR IF <br /> WORK IS SUSPI~NDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INKI'ALLATION oNLY <br /> <br />Supervlsor's License No. [ Phone. <br /> <br /> FOR OWNER INSTALLATIONS <br /> <br /> ,, I <br />City/gtatc~ip ,, ~ ~ <br /> <br />3. PLAN'RIEVI~W SRCTION <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) sels of plans and <br />specifications with this application. <br /> <br />MC L5,,.14 12/~4 <br /> <br />PERMIT NO; <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complet~ and enter total in Al below) <br /> Nut!abet of Inspections per peaTnit allowed -~ <br />A. <br /> ReeidentiM <br /> Pet <br /> Unit <br /> ~orvi~o Includ~t: l~ms Cost (*ach) Suni <br /> ~ch additional 5~ sq. fi, <br /> ~mi~d Enemy $20,~ ~I <br /> <br />B, ;$etvi,;ea or Feeder ~ (Does not include branch drcuits, see section D) <br /> <br /> ~0 amps or l~ss $30,~ ~ 2 <br /> 201 arum m ~0 am~ $~.~ ....... 2 <br /> <br /> ~1 amps ~ 1000 ~pa $130.00 2 <br /> ~r 10~ amps or vol~ ~,00 ~ 2 <br /> Reconnect only $~.00 2 <br /> <br />C, Tomp~ary SeevleedFeeders <br /> <br /> 200 amps or lc~ $33,00 2 <br /> 201 amps to ~0 amps $~.00 ........ 2 <br /> ~1 amps to ~ amps $~.00 2 <br /> <br /> pure'se of ae~ <br /> ~ch branch clmuit $ 2.~ <br /> <br />First branch cimuit <br /> <br />Each riga or outline lighting <br /> <br />Pack of 10 labol~ @ $5,00 eaoh <br /> <br />(As required by Building ot~elaD <br /> <br />$35.00 <br />$ 2,00 <br /> <br />$40,00 2 <br />$40.00 2 <br /> <br />$40.00 .......... 2 <br /> <br />$35.00 <br /> <br />__,W,/t, x $.0~ =__ <br /># of Labels Iq/(: <br /> <br />5, FEES <br /> A I, t~nt~r total of f¢~a from 8cc. #4 <br /> A2. Add 5% our*barge COS x Al) <br /> <br />Subtotal <br /> <br />B. Fmter 25% of linc A 1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fe~ (if mqnired) <br />D. Reinspe,~tion F¢~ ($25.00) <br /> <br /> TOTAL AMOUbrI' DUE <br />Race,pi No. ... <br /> <br /> <br />