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FOR CITY VALIDATION <br />Rc,'ccived by: <br /> <br />MARION COUNTY BUILDING INSPECTI~~ [~ 7~[~7 ~ ~-~ <br /> COMMUNITY DEV~EN~,SENTER ~ ~ <br /> Salem, OR 97301 ~ - ~ - <br /> J u 1,. - 3 ~995 <br /> O~e: <br /> ~ Hr ln~p~tion L~: 58~79~ MARION ~UUN t Y <br /> Office: 588-5147 <br /> F~: 588~7948 IssB~G INSPECTION <br /> <br />ELECTRICAL PERMIT APPLIGATION <br />P/ease complete ali Sections, 1 through <br /> <br /> 1. LOCATION OF INSTALLATION <br /> '"' <br />c,,, .gxancvitle .~s,. ~', H ~e~ . <br />.......... m~ C~k ~ <br /> <br />,, PERMITs AR~ NON-TRAN~FI:~RABLE AND EXPII~E IF WOP. K IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR Il: <br /> <br />2A. CO~RACTOR ~ST~LATION O~Y <br /> <br />2,B, FOR OWNER INSTALLATIONS <br />Property Owner (ploscpdnO <br /> <br /> Mailing Address j Phona <br /> CiqqStatdZ/p <br /> <br />3, PLAN REVIBW $1RCTION <br /> <br />Marion County does not require a plan review. <br />We will provkle plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specificatkms with this application. <br /> <br />MC' 1,5-,74 12/9~4 <br /> <br />4_ F]~]:I; SC}{]~DULE (Complete and enter total in Al below) <br /> <br />A. <br /> Unit <br /> <br /> Limited Energy $20,~ 1 <br /> Dwdllng 8¢~ice or F~¢&~ ~, $40.~1 _ 2 <br /> <br />Tho fee for brflach circuits <br /> <br />$50,00 __2 <br />$6O.00 __2 <br />SEY),00 __2 <br />$130.00 __2 <br />$3(X),00 __2 <br />$40.00 __2 <br /> <br />$S5,00 --.~ 2 <br />$40.00 .2 <br />$80,00 ____2 <br /> <br />$ 2.C0 -- <br /> <br />b) TI,, t~ for btan~h ¢imuit,~ <br /> P u re haae~ f scrvicc-0-tle'mlQ£J~-~ <br /> <br />Mi~ollan~ua (~viee ~ P~et Not ln~ud~) <br />~eh pump or iaigaaon ¢imle ~ $40,~ ~, 2 <br />~¢h ~i~ Oroutline IighlMg $~.00 ~ 2 <br />$ignal cimuit(a) or a limlmd ~ncrgy <br /> <br />Owr the allowable in any of <br />above, ~r Impc¢tion <br /> <br />Odd only fo eleetrical <br /> <br />(A~ rcqui~d by Building O~cial) <br />Au~m Dwelli~ <br /> <br />Dweltlng pcrmlt Label # of Labols,__ <br /> <br />$. FEES <br /> <br /> A2. Add 5'~, surcharge (,05 x Al) <br /> <br />B. Enter 2.5% of lin~ A 1 IBc Plan Review <br />(Se¢. 3), if required $__ <br />C, lnv~stigt~tion Fe~ (if reqttimd) <br />D. R~i~pcctlon Fee ($25.~) $ <br /> <br />Receipt No. <br /> <br /> <br />