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]FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITy DEVELOPMENT CENTER <br /> 285 Church St NE - Room 132 <br /> Salem, OR 97301 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Please completo al~ Sections, I through <br /> <br />L LOCATION OF INSTALLATION <br /> <br />24 Hr lflapee, tion Line: 581~7904 <br />Otticc: 588-5147 8;~ s.m. - 4:30 p.m_ <br />F~: 588-7948 <br /> <br /> 4. FB~ SCH~ (~mplctc and rotor total ~ Al below) <br /> <br /> R~ideltial <br /> Unit <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK I$ NOT <br />STARTflD WITHIN 1 &0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR l~O DAYS. <br /> <br /> 2A, CONTRACTOR INSTALLATION ONLY <br /> <br />............. .%z~7~ Lte~',...'~ ~ e~ot .~_~~[ <br />Property <br /> <br /> .?~,2:~.s!!? ~o_~,,~ ~,,, ._ ~__~-/-//c~.._ <br /> .~!,,,._~2~!!5,2_a,,~,_~. ~. No. tg/._~ ~ 7 ~ ~..~ob ~o. <br /> <br />,,, e., <br /> <br /> FOR OWHItR INSTALLATIONS <br /> <br />Prop~l~y Owner (pl~a~cprird) <br /> <br />3. PLANRRVIIqW $]~CTION <br /> <br />200 alnl~ or lean / $50,00 <br />200 amps or le~ ~5.~ 2 <br />~ bran~ circuit <br /> <br />Miacollan~,u$ (Sorvie~ or F~l~r Not Includ*d) <br />E~¢h pump ~ iwlgatbn ¢ir~lc .... ~, <br />~eh oi~ or outline lighting <br /> <br />Over the allowabl$ in any of ~ <br /> <br />(A~ t ~qtllred by Buildi~ O~ciaO <br /> <br />$40,00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />.... $50.00 <br /> <br />__.,.~a/. ~, x $,05 =~ <br /># of La~la N/~ . <br /> <br />IMarion County does not require a plan review, <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application, <br /> <br />5. FEES <br /> A I, Enter total of fees linm S~, g4 <br /> A2. Add 5% surcharge (.05 X Al) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />MC' O'-.t4 12A~ <br /> <br /> <br />