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FOR CITY VALIDATION [ <br />Reg¢ivvd by:, . . <br />Date: 7 ' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NB · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 Hr Ingpe~tion L~n~ 588-7904 <br />Office: 588,-5147 $:00 a.m. - 4:30 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSPERABL~ AND F.,XpIRE IF WORK IS NOT <br /> STARTED WlTHIN 180 DAYS OF ISSUANCI~ OR 1F <br /> WORK IS SUSPENDED POR 150 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWHI~R INSTALLATIONS <br /> <br />City/State/Zip <br /> <br />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 13-.~4 12iP4 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEl~ $CI'IF, D~fJL]~- (COmplete and tinter total ia Al below) <br /> g~eidomial <br /> <br /> Installation, A/l~ratlon os' Relocation <br /> 200 aznpa or <br /> 201 azn~ to <br /> <br /> ~1 amp~ to <br /> <br /> ~0 amps or loss <br /> <br />R. Mi~el~n~$ (~vJc~ ~ F~ Na Include) <br /> (~ req~ired by ~/I&~L~ O~clal) <br /> <br />$35.00 2 <br />$40.00_ 2 <br />$80.00 2 <br /> <br />$ 2,00 <br /> <br />$35.00 <br /> <br />$40.00 2 <br />$40.00 ~ 2 <br /> <br />$40,00 2 <br /> <br />$35,00 <br /> <br />$50,00 .. <br /> <br />Dwelli0~ Permit Label # of Labels <br /> <br />Al, Enter total ofl~es from See, #4 <br />A2. Add 5% surcharge (,05 x Al) <br /> <br />~$ttbtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />