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FOR CITY VALIDATION] <br />Received by: [ <br />Date: ~ <br /> <br />MARION COUNTY BUILDING INSPBCTION <br />COMMUNITY DEVELOPMENT CENTER <br />2~5 Church St Nl~ · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Liner 588-7904 <br />Office: $88-5147 8:00nJn.-4:30p.m. <br />FAX: 588-7948 <br /> <br />PERMff NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sect/one, 1 through 5 4. ~ SCHItDULB <br /> <br /> ~ R~id~l~l P~ Unit <br /> <br /> ~' I~sq.~ ~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 1 S0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />El,¢~rieal Contractor f~__i :C ~)~ '~ 1 phone "7(~ <br />h.,,,n.A,,.... __%< c t: <br /> <br />2B. FOR OWNrER INSTALLATIONS <br />Pw~rty Ownor (pl~o pdn0 <br /> <br />Mailing Address I Phone <br />city/State/Zip <br />Owner's Signature: <br /> <br />3. PLANRBVIBW 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 />M~ 15-34 12~4 <br /> <br /> Dwdling Set'vice or Feede~ $40.00 2 <br /> <br />B. ~e~viees er F,~ed~r s (Does not include branclI ei~cui~ nee section D) <br /> hu~aliadon. Alter&tiou ot Re/ozati~m $ c,.t~{~f..~ <br /> 200 amps or le~ ,. $50.00-~/ ), 2 <br /> 201 amp~ lo 400 am~ $60,00 -- 2 <br /> 401 amp~ to 600 am[~ $100.00 2 <br /> 601 aml~ to 1000 amps $130,00 2 <br /> <br /> Re~nne=t only $40.00 2 <br /> <br />C. Temporary Sefvleea/Feede~$ <br />[nstallatlon. Alteration. or Rel0eation <br />200 aml~ or k~s $35.00 2 <br />201 amps m 400 amp $40.00 2~ <br />401 aml~ 1o ~00 amps $80.00 2 <br />Over ~00 maps or 1000 volts <br /> <br />D, Branch Cireuits <br />New. Alterations. ~ Extension P~ Panel <br />n) Th= fee for branch circuits wilh <br />purchase of service of feeder fee <br />Each branch =ircult $ 2.00 -- <br /> <br />b) The fee for branch circuits Without <br /> <br />First b~ch ¢i~uit <br />I~¢h nddhionnl bnmch ¢imuit <br /> <br />$2.~__ <br /> <br />$50.00 -- <br /> <br /> sq. t~. x $.06 = <br />#ofLabelz. <br /> <br />N/C <br /> <br />PliES <br />Al. Enter Iotaloffe~ rom See.//4 <br />A2. Add 5% surchar~ (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Erect 25% of line Al for Plan Review <br /> (Sec. 3), if r~quir~d <br />C. Investigation F,~z (if r~qui~ed) <br />D. Relmpection Fee <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br /> <br />