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FOR CITY VALIDATION 3I~0 Labeler D~. NE- Suite C <br /> Salem, Oregon 97305-1398 <br />IReceivcd By: Date: <br /> <br />Date: 24 HR Inspection Line 373-4427 <br /> Office: phone 588-5147 8:00am - 4:30pm [SSll~d by: <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ail Sections, 1 through 5 <br /> <br />TAX ACCOUNT NO. <br /> <br />JOB ADDRESS <br /> <br />CITY <br /> <br />DIRECTIONS <br /> <br />pRO.CT DESC PTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br />Mailing Address City <br /> <br />FAX w w <br />Contractor Board Rcg No. <br />Supervisor License S <br />Signature of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <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 15-34 7/97 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> Number of Inspcctlons per psrmit nilow~d -~ <br /> 1 <br /> Items C~t (each) Sum / <br /> $85.00 4 <br /> <br />A. Residential Per Unit <br /> Service Included: <br />lO00 sq, it, or less <br />Each additional 500 sq. ff. <br /> or portion thereof <br /> <br />Mudniar Dwelling Service or Feeder <br /> <br />$15.00 <br />$20.00 I <br /> <br /> Installation, Alteration or Relocation <br /> 200 amps ~ less <br /> 201 amps to 400 amps <br /> <br /> a) The fee for branch ci~nits wi~ <br /> <br />E. Miscnilaneous (Service or Fe-.d~'r Not Iaeluded) <br /> <br /> above, per lnspsction <br /> <br /> (As reqni~ed by Building Officials) <br /> <br />$50.00 2 <br />$60.~0 2 <br />$100.00 2 <br />$130.00 2 <br />$300.00 2 <br />$40.00 2 <br /> <br /> $35,00 2 <br /> ~40.00 2 <br /> $80.00 2 <br /> <br />$2.00 <br /> <br />$35.00 ~~ <br /> $2.00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$50.00 <br /> <br />sq. ff.x $,06g =__ <br /> N/C <br /> <br />5. FEES <br /> A 1. Enter totni of fees from Sec. g4 <br /> A2~Add 5% sul~harge ?05 xAI) <br /> <br /> B. Enter 25% of line A1 for Plan P. cview <br /> <br />Receipt No. <br /> <br /> S <br /> $ <br /> $ <br />TOTAL AMOUNT DUE ~ <br /> <br /> <br />