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FOR CITY VALIDATION~ <br />Re~oivedby:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspeetiolx Line 373=4427 <br />Office: Phone S88-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />~LOCATION oF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~DED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />El~¢al Con~mctor ] Phone <br /> <br />~OR OWNER INSTALLATIONS <br /> <br />PLAN REVIEW SBCTION <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. FBII ~CHI~DUL]~ (Complete and enter tol~linAl below) <br /> Number of lnapo~tions l~ p~rmit allowed -~ <br />A. <br /> · wvie~Indud~d: ltoma Co~l(e~b) Sum I <br /> 1000 sq. ft. or less $85.00 4 <br /> Each additional 500 sq, ft. <br /> or ~tC~n *2~r~of $15,~1 -- <br /> L'uniled Energy $20.10 __1 <br /> Each Manufactured Horn, or Modular <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />B. Servioes or Feeders (Does not include brnneh ci~uit~ a*e section D) <br /> <br /> Installation, Alt~ratio~ m' Relocation <br /> 200 m~ or le~ $ffi.~ 2 <br /> ~1 am~ to ~ ~ $~.~ 2 <br /> ~t am~ m ~0 ~ $1~.~ 2 <br /> ~ 1 am~ ~ 1~ mpa <br /> ~or 1~ ~ps ~ vol~ ~.~ <br /> Reenact only ~.~ 2 <br /> <br />C. T~p~ary <br /> ln~al~tinn. ~i~fi~. ~ <br /> <br /> ~ am~ to ~ amp~ ~.~ <br /> ~l am~ to ~ ~ $~.~ 2 <br /> <br />D. ~ Cir~t~ <br /> <br /> a) ~e fee f~ b~ch c~ <br /> <br />b) The fee for branch ¢ir~uil~ without <br /> ~n:haae Qf service or feeder <br />First branch eirvuit <br />Each additional branch circuit <br /> <br /> E. Miscellaneous (Servieeor Feeder N~t Included) <br /> Each pump or in'igation circle $40.00 2 <br /> Each sign or outline lighting $.40.00 2 <br /> Signal ¢ircuiK$) or s limit~l energy <br /> panel, alto-etlon or extomion $40.00 2 <br /> P. Each additional Inap~lion <br /> Over the allowable in any of the <br /> above, p~r Inspection $35.00 -- <br /> (3. Minc~ lnatallatlon Labels <br /> Pack of 10 labels @ $~.00 each $50.00 <br /> <br />H. <br /> (As required by ~uildi~g Official) <br /> Aurora Dwelling Electrical Fee ~, ~. x $. 06~ ~ -- <br /> Dw~lFmg Pewait L~bel # o¢ Lab~.ls NlC <br /> <br />FEE8 <br />At, Enter total of f~es from Se~, g4 <br /> A2. AddS% surchargn (.05 xAl) <br /> Subtotal $.__ <br /> <br /> B. Enter 25% of line A 1 for Plan P,~vinw <br /> (Sec. 3). if required $,__ <br /> C. Investigation Fee (if required) $.__ <br /> D. Reimpcctinn Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUll <br /> Receipt No. <br /> <br />MC 1§-341/96 <br /> <br /> <br />