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FOR CITY VALIDATION <br />Reeeiv~l by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPBCTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NI~ · 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 />ELECTRICAL PERMIT APPLICATION <br />Please complote all 8~tlons, I through <br /> <br />PI~J~flTS ARE NON-TRANSFI~CM~L~ AND I~XHR~ IF WORK IS NOT ] <br /> ~fARTED 'W'ITHIN 1~0 DAYS OF ~,UANCE OR 1F <br /> WORK IS SUSPNNDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Job No, <br /> <br />]Phone# <br /> <br />Phone# <br /> <br />Properly Owner <br /> <br />Contractors L'w,~ ~ <br /> <br />Contractor's Board 1~ No. <br /> <br />Signature of Supervbi~ Blectrician <br /> <br />~.7~ 7.4 f7 <br /> <br />3. PLANRBVIBW 8BCTION <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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> lnmaEation, Alte~at~m or <br /> 200 amps or I=~ $50.00 2 <br /> 20t aml~ to 400 amp~ $60.00 2 <br /> 401 aml~ to 600 amps $ t00.00 2 <br /> 601 an~to 1000 amps $130.00 2 <br /> Owr lOOO amps or rolls $300.00 2 <br /> R~onnect only $40.00 2 <br /> <br />C. T~mpwary <br />lnsl~Jlation, ~ltion, or P.,~lo~tion <br />200 aml~ or lesa $35.00 2 <br /> <br />Over 600 amps or 1000 voll~ <br />D. Braae~ Cir~aits <br />a) Tbo fee for bra~ch cir~uiia ~ <br />Each branch ¢irouit $ 2.~0 <br />b) The leo for brtmch ¢ir~uit~ wiamm <br />Fimt branch chouit I $3~.00 <br />Each additional branch circuit 3 $ 2.00 <br /> <br />E. MisceEan~s (S~rvloe or Peedw Not Inoluded) <br />Each pomp oc in~ation ~le $40.00 2 <br />Each sign or outline ligl~ting $40.00 <br />Si,,onal ci~ui(s) ora limited energy <br />panel, alterafiml or exl~mlon $40.00 <br />F. Eaoh addi~knml l~ion <br />Over tbo allowable in any oflhe <br />abovo, pe~ lmpe~tion $35.00 __ <br />O. Minor l~.all~tio~ Labala <br />Pack of I0 labob @ $5.00 ~ach $50.00 <br />(sold oMy to elect~c~l aontt~ctor~9 <br />H. Othor <br />(Az t~quir~d by Boild~g Ofl~i~l) <br /> A~ Dw¢lY~wg E~'~i~ Fee sq. fi. x $,068 = -- <br /> Dwelling Permit Label # Of EaboIs. N/C <br /> <br />5. FEES <br /> Al. Enter to~al of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> $.__ <br /> <br />B. Enter25% of lineal forPl~P~vicw <br />(Se~, 3), if roquired $,__ <br />C. lnvesligation Fe~ (i f required) $.__ <br />D. Reimpection Fe~ ($25.00) $.__ <br /> <br />Receipt No. <br /> <br />MC 15~341/96 <br /> <br /> <br />