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FOR CITY VALIDATION <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPtiCTION <br /> <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 />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br /> Z03 Isr - <br />Dk~tlom <br /> <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br />Pwp~ny Owner ] Phone <br />Contraclor's License No. <br />Contractor's Board Reg. No. [ /ob No. <br />Signature of Supervising Electrician <br /> <br />2B. FOR OWi~R INSTALLATIONS <br /> <br />M~ilinsAddres. ~L)~.IiJ~),~ 7~'_~ j ~.o~e <br /> <br />3. PLANRBVIBW SI~CTION <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 /> Installation, Alteratioa o~ Relo0atinn <br /> 200 amps or less $50.00 <br /> 201 amp~ to 400 amps $60.00 <br /> 401 amps to 600 mnln $100.00 <br /> 601 aml~ m 1000 amps $130.00 <br /> Ov~ 1000 amp~ or vol~s $300.00 <br /> Reconnect only ~0.00 <br /> <br />C, Temp~rnry <br /> <br /> 200 amp~ or le~s $35.00 <br /> 201 amp~ to 400 amp~ $40.00 <br /> 401 amp~ to 600 amp~ $~0.00 <br /> Over 600 amp~ or 1000 volt~ <br /> <br />D. Branch Circuits <br /> <br /> n) The f~ fcr branch circuits with <br /> glgchase of service of feed~l~ ~ <br /> Each b~canch c~r~uit $ 2,00 <br /> <br />$35.00 <br />$ 2.00 -- <br /> <br /> ,¥q. fl. x $.068 = <br /># of Lal~ls. <br /> <br />5. FEES <br />Al. Enter totalof foe~ fwm Sec, #4 $.__ <br />A2. Add 5% surcharg~ 605 x Al) $.~ <br /> ~btmal $.~ <br /> <br /> B. ~r 25% of lineAl for Phn Renew <br /> (Sec. 3), if mqui~d $.~ <br /> C. l~esfigation Fee (if mq~) $.~ <br /> D, Reim~fion Fee ($25,~) $~ <br /> ~T~ ~0~ D~ <br /> R~eipt No. <br /> <br />MC 15-341/96 <br /> <br /> <br />