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.FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDIHG INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Insp~tion Line: 588-7904 <br />Otrnce~ 588-514'/ 8.'00 am. - 4:30pan. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />P~R.MITS ARE NON-TRAHSFERABLE AND EXPIRE IF WORK iS NOT <br />STARTED wrrHIH 180 DAYS OF ISSUANCE OR IF <br /> WORK 15 SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> I <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (ple.~ s~ print) <br /> <br />Marling Addre~m { Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLANREVIBW 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 />Date: <br /> <br />Issued by: <br /> <br />4. FHB 8CHHDULI{ (c,,mplete end enter~oU~inA~ below) <br /> Nmnber of Inspections per penui.'t allowed <br />&, Re~lembd i~r U~it I <br /> Servk~e lnebded: Items Cost (each) Sun <br />1000 sq. ft. or leas $85.00 4 <br /> or portion thereof $15.00 <br />Each Manufactured Hmne or Modular <br /> <br />~. 8m~k~ee er Po~nrs (Does not in~lud0 breneh eireuiU, see section D) <br /> Installation, Alteration or Rbioentioa ] ~ 2~ <br /> 2Q0mn~,or~ ( $50~0 <br /> <br /> 401 entire to (S~X) mnl)s $1QO.OQ <br /> 601 an~q~e to lOQO ~tnps $150.00 . 2 <br /> <br /> Reconnect only $40.00 . 2 <br /> <br />C. Teml~rary Servieea/Feeders <br /> lnstalhtion, Alteration, er Rdoeation <br /> <br /> 201 an~ to 400 en~ $40.00 2 <br /> 401 amps to 600 an~ $80.00 ~2 <br /> <br />D. l~aneh Cirenits <br />N~w, Alterations, er Extension Per Panel <br />a) The fee for brm~h cimui~s <br />.numlmse of service of feeder f~ <br />Each branch ¢~uit $ 2.00 <br /> <br /> ' b) Thz fee for bren~h ¢ireuiu wiflmut <br /> .mm:lmsz of servlee er feeder fee <br /> First branch eir~uit $35.00 <br /> Each additional branch circuit $ 2.00 <br /> <br />E. Mb~dlaneeus (Service or Feeder Not lnzluded) <br />Ea~ pump or itrigntion ¢irclz .~10.00 2 <br />Each sign or outline fighting $40.00 2 <br />Sisal e~uit(s) ora limited energy <br />pand, alteration or extension $40.00 2 <br />P. ~ additional Inspeefion <br />Over the allowable in any of the <br /> <br />O. Minor Inmallation Labd~ <br /> Pa~k of 10 labels <br /> Ooid only to electx~al eoat~¢to~) <br />H. Other <br /> (As required by ~tildiog OffwiM) <br /> Amora Dwelling Ele~a'ieai Fee <br /> Dwelling Permit Label # of Labek N/C <br /> <br />Al. Enter to~al oft~ from See./4 <br />A2. Add 555 aumhargo (.05 x Al) <br /> ~ubtotal $ <br /> <br />B. Enter 25% of linz Al for Plan Review <br /> (sex. 3), if required <br />C. Investigation Fez (if required) <br />D. Reinspo~tion Fee ($25.00) <br /> <br />TOTAL AMOUNT DUB <br /> <br />Receipt No. <br /> <br />MC 15-34 12/94 <br /> <br /> <br />