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FOR CITY vALIDATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspoc, tion Line: 588-7904 <br />Offlco: 588-5147 8:00 a.m. - 4:30 p_m, <br />g~: 588-7948 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections,,,. 1 through 5 .... <br />~I.~CATION OF INSTALLATION <br /> <br />~MITS A~ NON.~NS~RAB~ AND ~PIRE IF WO~ 1S NOT <br /> STAR~ ~IN 1 ~ DAY8 OF ISSUANCE OR IF <br /> WORK IS SUSP~D~ FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Electrical Conlrack>r "[ Phofi¢ <br /> <br />Mailing Addr~s <br />Propcrty Owner [ Phone <br />Coniractor~a Li0enso No, <br />Cootraetor'a Board Rgg. No. [ ,lob No. <br /> <br /> 3. PLAN REVIEW SIiCTION <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 />~ 1.5-.14 12,a:M <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. Fltlg SCHFfl)ULB (Ccnnplete and ¢i1~1~1' total in Al below) <br /> Nun~bee of lnapeclions pet permit allowed ~ <br />A. <br /> R~t~}dent iai <br /> Unit <br /> <br /> I000 ~q. fl, or less $85,00 4 <br /> <br />(sold only lo electricM ¢oatcactors) <br /> <br /> $50.00 fSO, °t~2 <br /> $oo.oo __ 2 <br />$100,00 2 <br />$130,00 -- 2 <br />1000.00 __ 2 <br />$40,00 2 <br /> <br />$35,00 __2 <br />Sa(bOO __2 <br />$80,00 2 <br /> <br />$ 2.00 <br /> <br />$35,00 <br />$ 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 />5. FEES <br /> <br /> A2. Add 5% sm'~hargc (-05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A I for Plan Review <br /> (Sec. 3), if mquit~d <br />C. Investigabon F¢~ (il'requlred) <br />D, R~insDeetkm Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipl No. <br /> <br />$ <br />$ <br /> <br />$ <br />$ <br /> <br /> <br />