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]FOR :ITY 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 Inspection Lhw: 588-7904 <br />Oflie~ 588-5147 8:00 ann. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />];~RMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR. IF <br /> WORK IS SUSPENDED FOR lS0 DAYS, <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br />: Mailir~g Address <br /> <br />Properly Owner [ Phone <br /> <br /> FOR OWNER INSTALLATIONS <br /> <br />~p~y Owner &l~ ~rint) ' [ ~ ~ <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br /> Marion County does not gequire a plan review, <br /> We will provide plan review ~ervice if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC l J-J4 12F94 <br /> <br />4. FE]~, SCHEDULE (Complete and enter total in Al below) <br /> Unit Number of ln~p¢¢liona pet p*mlit allowed <br />A- <br /> R~idatttial <br /> <br /> 10ft) sq. ft. or Io~s $85.(Xl <br /> Dwelling Service or Feeder $40.00 <br /> <br />b) The lee for brawJh circuits <br /> vurrlxa~a,o f ~rvk ~ or .fc~f~ <br />First brach ~ireuh <br />~ch additional branch eimult <br /> <br />(~ required by ~nildi~ <br /> <br />$50,00 .~2 <br />$60,00 2 <br />$100.00 ----. 2 <br />$130.00 2 <br />$300,00 -- 2 <br />$40,00 2 <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 />$50.00 <br /> <br />__.sq, ~. x$.05 =__ <br />#ofLab~ls, N/C__ <br /> <br />5, FEES <br /> <br /> A2, Add 5% sure~harg~ (.05 x A 1) <br /> Subtotal <br /> <br /> B- I~nter25% oflia~Al for Plan Review <br /> (See. 3), if r~quired <br /> C, Investigabon Fee (i f requigd) <br /> D, Reimpe~tlon Fee ($25,~) <br /> <br /> TOT~ ~OU~ DUE <br /> <br />$ <br />$__ <br /> <br />$ <br />$ <br />$ <br /> <br />53J0-070 <br /> <br /> <br />