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FOR CITY VALIDATION[ <br />Ro~elved by: . <br />Date: <br /> <br />MARION COUlqTY BUILDING INSPIICTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem. OR 97301 <br /> <br /> 24 hr. lnspeetton Line 37~4427 <br />Office: Phone S~-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete ~1 Sections, I through <br />~OCATION OF I~8TALLATION <br /> <br />PERh, ffTS ARE NON-TRAHSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 1 ~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Phone <br /> <br />Mailing Addreas <br />~p~ Owner I <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Rng. No. <br /> <br />Signatu~ of Supervising Electrician <br />Suparvi~or's Liceme No. I Phone <br /> <br />~.~R OWNILR INSTALLATIONS <br /> <br />3. PLANREVIEW SECTION <br /> <br />Marion Count), 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 15-341/96 <br /> <br />Dato: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and ente~: total in Al below) <br /> Number of Impeetinna pe~ p~nnit allowed -~ <br />A. <br /> Residential <br /> Unit <br />~ervio~ Ineludud: Items Coat(each) Sum <br />1000 sq, fl, or less $85,00 4 <br />Each additional 5~0 sq. fi. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Servi¢o or Feuder $40.00 2 <br /> <br />B. ~ o~ Feeders (Does not include Immch circuits, see s~tlon D) <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 601 amps to 1000 amps <br /> Over 1000 amps or volts <br /> Reconnect only <br /> <br />C. Temp~ary 8~vlo~F~l~s <br /> <br /> 200 amps or leas <br /> <br /> n) Th~ f~ for branch cireui~ wilh <br /> <br /> Each ~ign or outlln~ lighting <br /> <br /> P~l~ of 10 inb~h @ $5.00 each <br /> <br /> (As reqnir~d by Building Ol~i,s <br /> <br /> Dwelling Permit Label <br /> <br />$60.00 2 <br />$100.00 2 <br />$130,00 2 <br />$300.00 2 <br />$4O.OO 2 <br /> <br />$35.~ 2 <br />$40,~ 2 <br />$~.00 2 <br /> <br />$ 2.00 ~_~ <br /> <br />$35,00 <br />$ 2.00 <br /> <br />$40.00 2 <br />,~0.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> xq. fl. x $.068 =__ <br /># of Lal~l~ N/C <br /> <br />FEES <br />Al. Enter totel of fees from Sec. g4 <br />A2. Add5% sumhargo (.05 xAl) <br /> Eabtotal <br /> <br />B. Enter25% of lineAl forPlanReviow <br /> (Sec. 3), if ~equired <br />C. Investigatioa Fee (ifrsquired) <br />D. Rcinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> R~eeipt No. <br /> <br /> <br />