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FOR CITY VALIDATION' <br />IReceived By: <br />IDate: <br /> <br />BUILDING INSPECTION DMSION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone S88-S147 8:00am - 4:30pta <br />FAX S88-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION <br /> OF <br /> INSTALLATION <br /> <br />/o / 6- ¢ -- O O <br />JOBADDRESS il~qcl B~J~ <br /> <br /> CROSS S~ET/ <br /> <br /> P~TS ~ NON-~SFE~LE A~ E~I~ IF WO~ IS NOT <br /> STATED ~ 180 DAYS OF ISSU~CE OR IF <br /> WO~ IS SUSP~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br />Mailing Address City <br /> <br />Phone l <br />FAX ,-~ -,- <br />Contractors License No. m C <br />Contractor Board Reg No. <br />Supervisor License S <br />Signature of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> City, State, Zip ~'~J~U/qJ~//"l)e ~r qTSAg <br /> Phone Islcb 1-171 ,lgl-I/l l -I l <br /> <br />3. PLAN REVIEW SECTION <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 />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />A. Resld~nfia[ Per Unit <br />Service Included: <br />10~0 sq. it. or less $85.00 <br />Each additional 500 sq. it. <br />or pertlon thereof $15.00 <br />Limited Energy $20.00 <br />Each Manufactured Home or <br /> <br />B--~ Feuder~ (Does ne~ include branch circui~ ~ section D) <br /> 2~0 ampsI~i'If~tle~r IA~s:mf4°n er Retec~"~ L~~ $50,00 __ <br /> <br /> $60.00 <br />401 amps to 600 amps $ 100.00 <br />601 amps to 10~0 arni~ $130.00 <br />Over 1000 amps or volts $300.00 <br />Reconnect only $40.00 <br />C. Tempora~ service/Feeders <br /> <br /> pump or irrigation circle ~ .) <br /> <br />5. FEES <br /> Al. Enter total of fees from S~. #4 <br /> A2. Add 5% aurcharge (.05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Inveztigatlon Fee (i f requlmd) <br />D. Reinspection Fee ($25.00) <br /> <br />ReceiptNo. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 7/97 <br /> <br /> <br />