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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 pr:RMff NO: <br />Salem, OR 97301 <br /> <br /> Date: <br />24 hr. lnspe~ion Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 Issued by: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all ~ections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERM1TS ARE NON-TRANSFERABL~ AND EXPIRE IF WORK IS NOT [ <br /> I <br /> WORK IS SUSPENDED FOR la0 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />:lB. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (p.¥~sepHat) <br /> <br />Mailing Address I Phone <br />City/Stats/Zip <br />Owner's Signature: <br /> <br />3. PLANRI~VIEW 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 />4. ~ SCHIIDULE (Comple~ and enter total in A 1 below) <br /> <br />A. Reeidemial Per Unit Number°fln~Fectlons p~ permit allowed <br /> <br />~a'~ee Included: Items Coat (each) Sum <br />1000 sq. Il. or le~ $85.00 <br />~ach additional 500 zq. ft. <br /> ~ portion thereof $15.00 -- <br />Limited ~n~ $~O.00 <br />Each Manufnetur~l Home or Modular <br /> Dwelling S~cvice or l~d~ $40.00 <br /> <br />B. S~vieea ~ Peeder ~ (Does not include bomeh circuits, se,~ a~tlon D) <br /> installation, AJtacotlon er Relocation t <br /> 200 amps or less t $50.00,,~.~ <br /> 201 amps to 400 amps $60.00 <br /> 401 amps to 600 amps $100.00 <br /> 601 nmt~ to 1000 amps $130.00 <br /> Over 1000 amps or volts $300.00 <br /> Reconnect only $40.00 <br /> <br />C. Temporary 8e~viaeatFeede~s <br />la~taEation, Aide, atica, or Reloeatlon <br />200 amps or l~ $35.00 <br /> <br /> 401 amps to 600 amps $80.00 <br /> Over 600 ~anpe or 1000 volts <br /> <br />D. Branch Circuits <br /> New, Alteration, er Extendon Pe~ Panel <br /> a) The fee for branch eir~ults with <br /> <br /> Each branch circuit $ 2.00 <br /> <br />b) The fee for bran0h cimuits without <br /> purchase of service or feeder fee <br />First branch circuit <br />Each additional branch circuit <br /> <br /> E. MiseeEanec~s (l~vie~ ~ F~da' Not Inelu~) <br /> ~oh pump ~ ~gafion ci~lo ] <br /> <br /> Si~ c~uit(6) or a ~d ~ <br /> ~nel, elt~fion or ext~ion <br />F. ~ add~io~l I~ion <br /> ~er t~ allowable ~ ~y of ~e <br /> <br /> ~ck of 10 lnbda ~ $5,~ ~h <br /> (~d o~ to el~t~a l contr~ctots) <br /> <br />$35.00 <br />$2.00 <br /> <br />$40.0O 2 <br /> <br />$50.00 <br /> <br /> ,vq. fl. x $.068 = <br /># of Labels N/C <br /> <br />FEES <br />Al. Enter Iotaloffeea from Sec. #4 <br />A2. Add 5% surcharge $05 x Al) <br /> Subt~al <br /> <br />B, Enter 25% of line At for plan Review <br /> (Sec. 3), if roquked <br />C. Investigation Fee (if required) <br />D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DU~ <br /> Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />