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MARION COUNTY BUILDING <br /> <br />FOR CITY VALIDATION 285 ChurchSalem, St OR NE' 97301 Room <br />Received by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Please complete ali Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND F..XPIKE IF WORK I$ NOT <br />STARTED 'WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAY$. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />~. FOR OW~ ~ST~LATIONS <br /> <br />~pefly Owner ~lea~o prinO <br /> <br /> Mailing AtJg~e~s J Phone <br /> Cily/State/Zip <br /> Owner's $1gnatum: <br /> <br />3. PLAN RBVIBW SBCTION <br /> <br />IMarion County does not require a plaa 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-.14 12/94 <br /> <br />4. F~B SCH~)ULB (Complete and enter total in A 1 below) <br /> <br /> Dwellin~ Service or Feeder ~ $40,ff0 d-frO <br /> <br /> 200 amp~ o~,, ~ $~0.00 ~ <br /> 201 ampa to ~0 amps $~.00 ~ <br /> <br />E. Miscellaneous ($~vioe ~ Feeder N~ Inebldeg) <br /> Eaoh pump or i~igation circle <br /> ~eh si~ or outlin* Iigh~ng <br /> 5i~al cimult(O or a Iimit*d clingy <br /> <br /> Pa¢k of 10 labe~ ~ $5,00 each <br /> <br /> (A~ r*qnircd by Bnil~it~ O~eial) <br /> <br /> Dwelling Pemit ~bel <br /> <br />$2.00 o~'~ <br /> <br />$35,00 <br />$ 2.00 <br /> <br />$40.00 2 <br />S4o,oo 2 <br /> <br />$40,00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />__.~q. g. x$.06 =__ <br /># of Labels, ~I/_C,_ <br /> <br />Al. Enter total o£ fees from See. #4 <br />A2, Add 5% surcharg,~ (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 for plan Review <br /> (Sec. 3), it required <br />C~ Investigation Feo (ifr~qui~d) <br />D. Reiospeetioa Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. <br /> <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />