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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE * Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 3734427 <br />Office: Phone 588-5147 8:00am - 4:3~pm <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />OCATIONOF I~STALLATION <br /> <br /> I~RM1TS ARE NON-TRANSFERABLE AND EXPIRE 1F WORK IS NOT <br /> STAR]ltD WITHIN 180 DAYS OF ISSUANCE OR l!n <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />( 2A.)OHTRACTOR INSTALLATION ONLY <br /> <br />Phone# <br /> <br />pr~etW Owner <br /> <br />Fax// <br /> <br />Phon~ <br /> <br />inb <br /> <br />liB. FOR OWNI[iR INSTALI,ATION$ <br /> <br />3. PLAN R~VIBW SBCTION <br /> <br />M~ion 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 />MC 15-34 1/96 <br /> <br />4. Pl]li SCHHDULH (Complete and enter total in Al below) <br /> <br />A. <br /> Rezidentiel <br /> Unlt <br /> <br />1000 sq. fi. of less $85.00 4 <br />Each additional 500 sq. ft. <br /> or port/on thereof $15.00 <br />Limited Energy $20.00 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 2 <br /> <br />B. S~-~i~ o~ Feedet s (Do~ not ineindu Ixanch circuits, s~¢ section D) <br /> <br /> Inatallation, Alteratinn or Relocation <br /> 200 amps or less $50.00 2 <br /> 201 amps to 400 amps $60.00 2 <br /> 40 t amps [o 600 amps $ lO0.OO 2 <br /> 601 amps to 1000 maps $130JX) 2 <br /> Over 1000 amps or volts $300.00 2 <br /> Reconnect only $40.00 2 <br /> <br />C. Tempctary ~a'vie~iFeddera <br />In~aEatlon, Alteration, or Relocation <br />200 amps or Less $35.00 2 <br />201 amps to 400 amps $40.00 2 <br />401 amps to 600 amps $80.00 .. 2 <br />Over 600 amps or 1000 volts <br />see 'gl <br />D. Branch Cir~uita <br />New, AltetatlonB, or Bxtonalo~ Pet Panel <br />a) The fee for brach ¢ircints <br /> <br /> Each branch circuit $ 2.00 <br /> <br />b) The fee for branch circuits without <br />purchase of service or feedur fe~ <br />First branch circuit $35.00 <br />Each additional brach circuit $ 2.00 <br /> <br />E. MiseeEaneous (~'vieo ct Feede~ N~ Include) <br />~ch p~p ~ ~gation circle $~.~ 2 <br />~h al~l or o~u~/t~g ~,~ <br />Si~al ci~uit(a) ora ~itsd en~ <br />panel, alt~ti~ or ~t¢mi~ $~.~ 2 <br />F. Ea~ additi~l ln~ion <br />~er the allowable ~ any of~ <br />~vc, ~r ~lion $35.~ <br />~. Min~ In~aEation <br />~ck of 10 labeh ~ ~.~ ~ch $~.~ <br />(~d o~ to el~aM eomracto~) <br />H. Oth~ <br />(~ required by Buildi~ <br /> Aumn ~elling El{~tfical Fee sq. ft. x $.068 = <br /> ~allMg Pe~it ~bel <br /> <br /> 5. FEES <br />, Al. Enter total of fees from Seo, #4 <br /> <br />A2, Add 5% surcharge (.05 x Al) <br /> <br />Subtotal $.__ <br /> <br />B. Enter 25% of line A 1 for Plan ReView <br /> (Sac. 3), if requi~ed <br />C. Investigation Fe0 {ifrexluired) <br />D. Reinspeetion F~ ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />