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FOR CITY VALIDATION <br />Received by: <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. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job Description: <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~IDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION OHLY <br /> <br />Electrical Contractor <br /> <br />Address <br /> <br />Property Owner <br /> <br />Con,racers Liceme No. <br /> <br />ConU-actor's Board Peg No. <br /> <br />Signature of Supervisin~ Electrician <br />Supervisor's License No. <br /> <br />Fax~ <br /> <br />Phone~t <br /> <br />Job No. <br /> <br />[ Phon~/ ] <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />MailingAddre~ ~2.(~j~t~J ~ Phone <br /> <br /> :5. PLANRBVIEW 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 />MC 15-341/96 <br /> <br />4. FEE SCHEDULE (Complete and enter tolal in Al below) <br /> Number of Inspections per permit allowed <br /> Unit <br />Sen'vlao Included: Items Cost (each) Stma <br />1000 sq. fl. or less $85.00 4 <br />Each additional 500 sq. ft. <br /> <br />200 amps or 1~ $35.00 -- <br />201 amps to 400 amps $40.00 -- <br />401 amps to 600 amps $80.00 <br /> <br />a) The fee for branch eireuila ~ <br /> <br />$35.00 -- <br />$ 2.00 -- <br /> <br />E. Miscellaneous (Service c~ Feeder N~ Include) <br />~ch pump or i~igafion title ~.~ ~ <br />~ch si~ or outl~e li~thg $~,~ <br />Signal c~c~s) or a lhnited envy <br /> <br /> Over t~ allowable in any of ~e <br /> a~ve, per ~pe~ion $35.~ ~ <br /> <br /> Pack of 10 l~e~ ~ $5.~ ~eh $50,~ ~ <br /> (sold on~ to el~tric~ l contrs~tors) <br /> <br /> (~ r~red by ~ildi~ <br /> Au~ra ~elling Elee~cal Fee <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br /> <br />2 <br /> <br /> ~q. fl. x $.068 =__ <br /># of Labeb__ ~ <br /> i <br /> <br />5. FEES <br />Al. Enter total of fe~s from Sec.//4 $.__ <br />A2. Add 5% surcharge 605 x Al) $.__ <br />~ubtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required $.__ <br /> C, Investigation Fee (if required) $.__ <br /> D. Reinspeetion Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE $.__ <br /> Receipt No. <br /> <br /> <br />