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MARION COUNTY BUILDING INSPECTION <br /> <br />FOR CITY~V/~I~ATION~ [ <br />Rmeiv_~l b~J ~ <br /> TM [ <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · 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 /> <br />Issued by~ <br /> <br />I Please complete all Sections, I through <br />1. LOCATION OF INSTALLATION <br /> <br />4. FEll SCHBDULE (Complete and enter total in Al be[ow) <br /> Number of lnsp~otions per p~rmit allowed ~ <br />A. <br /> Resld~ntial <br /> Pet <br /> Unit <br /> Service Included: Items Cozt (e~ch) Sum i <br /> 10O0 sq. fl. or less $85,00 4 <br /> Each additional 500 sq. ft. <br /> or portion thereof $15.O0 <br /> Limited Energy $20.00 1 <br /> Each Manufactur~t Home or Modular <br /> Dwelling Service or Feeder $40.00 -- 2 <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EX]qRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2.4. CONTRACTOR INSTALLATION ONLY <br /> <br />200 amps or legs <br />201 amps to 400 amps <br />401 amps to 600 amps <br />601 amps to 1000 amps <br />Over 1000 amps or volta <br />Reconnect only <br /> <br />C. Temporary <br /> <br />Electrical Contractor <br /> <br />Addre~ <br /> <br /> lnsiallatina, Altecation, or Redooation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 mnps to 600 amps <br /> Over 600 amps or 1000 yells <br /> <br />D. Branch Circuits <br /> <br />Con,actors Lkem¢ No. <br /> <br />Contractor's Board Reg No, <br /> <br />lob No. <br /> <br />Signature of Supervising Electrician <br /> <br /> I <br />Supervisor's Licens~ No. ] Phone~ <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SI~CTION <br /> <br />Marion County does not requir~ 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 /> $50.00 2 <br /> $60.00 -- 2 <br />$100.O0 2 <br />$130.00 2 <br />$300.O0 2 <br /> $40.00 -- 2 <br /> <br /> $35.00 2 <br /> $40.O0 2 <br /> $8O.O0 2 <br /> <br />$ 2.00 <br /> <br />$35.00 <br />$ 2.0O <br /> <br />E. Mi~cdlan~ous (~'vie~ or F~det Not <br />~ch p~p ~ i~gat~n c~le ~.~ 2 <br />~ch si~ or outl~e li~t~g ~.~ 2 <br /> <br /> ~ the allowable in ~y of ~ <br /> a~ve, ~ ~pection $35 <br /> <br /> ~ek of 10 labels ~ $5.~ ~ch $~.~ <br /> ~ell~g Pe~it ~bel g of ~. NIC <br /> <br />5. FEES <br /> A I. Enter total of fees from Sec. #4 <br /> A2. Add5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Eater 25% of line Al for Plan Review <br />(Sec. 3), if required $.__ <br />C. Investigation Fee (if required) $___ <br />D. Reinspeetion Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUI~ <br />Receipt No, <br /> <br />MC 15-34 1/96 <br /> <br /> <br />