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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 />24 Hr In~p~tion Linc: 588-7904 <br />Off'~ 588(5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATIONI <br />1. LOCATION OP' ] ISTALLATION <br /> <br /> P~R IvlIT$ ARE NON.TRANSFERABLE AND F. XPIRE IF WORK IS N~T <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 18 $USPENDED FOR 180 DAYS, <br /> <br />2,A; CONTRACTOR. ]2~,.STALLATiON ONLY <br /> <br />Property Owner ~hone <br /> <br />2B. FOP. OWNER IlqSTALLATIONS <br /> <br />lhDperty Owner (ple~ prinO <br /> <br /> Mailing Add~a~s [ Phone <br /> City/State/Zip <br /> Owner's $ignatare: <br /> <br />3. PLAN REVIEW 81~CTION <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 12/94 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FI~H SCHF:ff)IJLE (Conlpleta alld entex total in Al below) <br /> <br />10~ sq, fl, ~ less $85.~) 4 <br /> or ~ion ~ereof $15.~ <br /> Dwelling Sexier or Feed*r / $40,~ ,2 <br /> <br />20~amps or less $.~.00 __ 2 <br />201 amps to 400 amps $60.00 2 <br />401 amps to 600 amps $100,00 -- 2 <br />601 amps to 1000 ~mps $130,00 , 2 <br /> <br /> ourchns~ o f2~Eyj~o~q~ <br /> <br />Each pump or irrigation circle <br />~aeh sign or outline lighth~g <br />Signal circuit(s) or a limited energy <br /> <br />Over thc allowable in any of <br /> <br />Pack o~ i0 labeI8 <br /> <br />(~ z'eqoirod by Baildi~ O~claD <br />Aurora Dwelling <br />Dwelling Pennit ~bel g of ~ls, <br /> <br />Miacollaneoua (Service or Feeder N~ Included) <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 />$50.00 <br /> <br />N/C _ <br /> <br />5. FEES <br /> A 1, Elltat tohfl of fees from Sec. #4 <br /> A2. Add 3% surcharge (,05 x Al) <br /> <br />B, Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required <br />12, Investigation Fee (il'requited) <br />D, Reirmpeetkm Fcc ($25,00) <br /> <br /> TOTAL A/VlOUNT DUE <br /> Receipt No, ,, <br /> <br /> <br />