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~OR CITY VALIDATION MARION COUNTY PERMIT NO: ~1~7. d 7~) <br /> BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr, NE - Suite C <br /> Salem, Oregon 97305-1398 Date: <br /> Received By: <br /> <br />'lDate: '] 24 HR Inspegfion Line 373-4427 <br /> Issued <br /> by: <br /> Omce: ph~;~0am - 4:30pm <br />IELECTRICAL PERMIT APPLICATION t~~'~' ~ <br /> ........,,. _. I . F E SCHEDULE (Complete and enter total in A1 below) <br /> /~/ease <br /> complete <br /> afl <br /> ~ection$, <br /> ltlro~lldtt 5 ....t3 Numbec of Inspections per permit allowed <br /> ~t ~.~ : l.]. A. Residential Per Unit <br /> Items Cost (each) Sum <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br /> JOB ADDRESS <br /> <br /> CITY <br /> <br />t <br />PERMITS ~ 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 />.hone 5-03-'7*- 9-q I <br /> 5 0,3 -7b - <br />Contmctors License No. ~ -- I ~ ~ C <br />Con,actor Board Reg No. q g ~ ' ~ ~ <br /> <br />Property Owner (please print) <br /> <br />Mailing Address <br /> <br />City, State, Zip <br /> <br />Owner's Signature <br /> <br /> or less $85.00 4 <br /> <br />or paralan thereof $15.00 <br />Limited Energy $20.00 I <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder $40.00 2 <br /> <br />B. Services or Feeders {Does nat include branch cBcuits, see section D) <br /> <br /> Installation, Alteration or Relocation <br /> <br /> 20i amps to ~ amps <br /> 401 amps to 600 amps <br /> 601 amps to I000 amps <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alterations, or Relocation <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> <br />D. Branch Circuits <br /> New, AIteration~ or Extension Per Panel <br /> a) Tile fee for branch circuits with <br /> <br /> Each branch circuit <br /> h) The fee for branch circuits without <br /> <br /> First branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irrigation circle <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited energy <br /> <br />F, Each additioanl Inspection <br /> Over the allowable in any of the <br /> <br />$60.00 <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 />s2.oo <~. ~ <br /> <br />S35.00 <br /> $2.00 <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />sq. ft. x $.068 = __ <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 />5. FEES Al. Enter total of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec, 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />