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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br />FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />285 Church St NE · Room 132 <br />Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Off'lC~: 588~5147 8:00 n.m. ~ 4:30p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />ZA. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br /> Phone <br /> <br />Mailing Address <br />Contractor's Board Reg. No. ] Job No. <br /> <br /> 2B. FOR OWNtlR INSTALLATIONS <br /> <br />Marion Co~ does not r~ui~ a plan ~eview. <br />We will provide pl~ review se~ice if you complete <br />Scc~on ~B and submi~ ~o (2) se~ of plans ~d <br />specificatio~with ~is applica~on. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEti SCHEDULE (Complete and enter total in Al below) <br />fi.. R~idential P~r Unit Number oflnspections p~r permit <br /> ~e~vice Included: Iterm Cost (each) Su <br /> mt <br /> 1000 sq. fi. or less $85.00 4 <br /> <br />B. 8~vk~ ~ l~eoe~ s (~es not include b~anch circui~ see aectinn D) <br /> Installati~. Altor~n or Roloeatlim ~ ..~ <br /> 200 ~m~or"t~ I ~ s~o.0o <br /> 201 amps to 4~0 amps ~ ~ $60.00 -v-- 2 <br /> <br /> 200 amps or less $35.00 2 <br />201 amps to 400 amps $40.00 ~ 2 <br />401 amps to 600 amps $80~ 2 <br />Over 600 ~ps or 1000 volts ~ ~ ~ <br />s~e "B' above ~ i <br />D. Branch Ch',nits <br /> <br /> Each branch circuit {;~ $ 2.00 <br /> <br /> Signal circuit(s) or a limited energy <br /> <br /> (Az required by Buil&'~g Official) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. g4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> Eabtotel <br /> <br /> B. Eater ~5% of line Al for Plan Review <br /> (Sec. 3), if r~quir~d <br /> C. Investigation Fee (if required) <br /> D. Reinapection Fee ($2~.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />