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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br /> Office: phone 588-5147 8:00am - 4:30pm <br /> FAX 588-7948 <br /> <br />PERMIT NO: <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 />TAX ACCOUNT NO. <br /> <br /> PROPERTY OWNER <br /> <br /> Serviee Included: <br />10~0 sq. ft. or less <br />Each additional 500 sq. ft. <br /> or portion thereof <br />Limited Energy <br /> <br />~Complete and enter total in Al below) <br /> <br /> $85.00 4 <br /> <br />$15.00 <br />$20,00 <br /> <br />Modular Dwell' ' or F~der $40.00 <br /> <br />CROSS STREET/ <br /> <br />PROJECT DESCRIPTION{` <br /> <br />Over 1000 amps or volts <br /> <br />$50.00 ~ 2 <br />$60.00 __ 2 <br />$I00.00 2 <br />$130.00 2 <br />$300.00 2 <br />$40.00 2 <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 />2B. FOR OWNER INSTALLATIONS <br /> <br /> Proper~y Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <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 />MC 15-34 7/97 <br /> <br /> 200 amps or less ~ <br /> 20l amps to 400 ~nps <br /> 401 aml~ to 600 amps <br /> Over 600 amps or [000 volts see "B" above <br />D. Branch Circuits <br /> <br />$35.00 ~ <br />$40.00 2 <br />$80.00 2 <br /> <br />s:.oo /'/~° <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />FEES <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (See. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. __ <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />