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FOR CITY VALIDATIONI <br />Received by: [ <br />Date: ,:./ .... ! ~ [ <br /> <br />MARION COUHTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> IOq <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (plet s~ print) <br /> <br />Mailing Address [ Phone <br /> <br /> City/State/Zip <br /> <br /> Owner's Signature: <br /> <br />3. PLANRBVIgIW 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 />Pi~RMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. F~E SCH]~DUL~ (Complete and enter total in Al below) <br /> Nmnber of In~peetion~ <br /> aliowod <br />A. Rm~idontiai Per Unit <br />survio~ Included: Iten~ Cest (each) Sum I <br />1000 ~q. ft. or learn $85.00 4 <br />Each additional 500 aq. ft. <br /> of poaion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Hmne or Modular <br /> <br />E. 8~qo~ of Fm~lof~ (Do~ not i~lnd* brach ¢i~.ni~ ~ -ection D) <br /> <br />Installation, Alteration or R~do0ation <br />2OO ~ml~ or I~ <br />201 aml~ to 400 mnl~ <br />401 ~ml~ to 600 mnt~ <br />601 aml~ lo 1000 amps <br />Over 1000 amps or volta <br />Reconnect only <br /> <br />Temperary ~e~v~e~F~iers <br />Installation, Alteration, or Relocation <br />200 amps or less <br />201 aml~tO400amim ,, , <br />401 amt~ tO 600 amt~ <br />Over 600 aml~ or IOO0 volta <br />SeC "B" above <br />Branch Cirouita <br />lq~w. Alterations, of Exton~km Per Pand <br />a) The fee for branch ¢ireuita with <br /> purchase of aervice of feeder fee <br />Each branch circuit <br /> <br />$~0.00 2 <br />$~0.00 2 <br />$100.00 ~ 2 <br />$130.00 2 <br /> <br /> $40.00 2 <br /> <br />Do <br /> <br /> $35.00 ~ 2 <br />.,, $4O.0O ,2 <br /> $80.00 2 <br /> <br />b) The fee for branch circuits without <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br />$ ZOO __ <br /> <br />$35.00 <br />$ 2.00 <br /> <br />E. Misedlaneons (survie~ er Femler Not Included) <br />Each p~p ~ ~ c~ie ~.~ ~ 2 <br />~ch si~ or ourse ~t~g ~.~ ~ 2 <br />Si~ c~t(s) or a i~i~ en~ <br />p~ei, alt~fi~ or ex~i~ ~.~ ~ 2 <br />F. ~ addit~l l~n <br />~ ~e allowable ~ ~y of ~e <br />a~ve, ~r ~p~t~n $35.~ ~ <br />O. Min~ In~t~ ~bMs <br />Pack of 10 I~ O $5.~ ~ch $~.~ <br />(~d oMy to vlec~icM co~r~ctors) <br />H. 0~ <br /> <br /> A~ ~elling El~cal F~ <br /> ~ell~g Pe~it ~1 <br /> <br />~sq. )~. x $.068 <br /># of Labela <br /> <br />5. FEES Al. Enter total of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Eoter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOUHT DUE <br /> <br />Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />