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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 Inap~ction Limg 588-7904 <br />Off'~ 588-$147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSF/~RABLE AND P, XPIR~ IF WORK IS NOT <br /> STARTED W1THIN 180 DAYS OF ISSUANCE 0RiIF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />E{ectticalConttaetor ~~ Phone~R~7~/~j~ <br />Malb Address -- ---~J----' <br /> <br /> 2B. FOR OWNF~R INSTALLATIONS <br /> <br /> Properly Owner ~deaac print) <br /> Mailing Addres~ I Phone <br /> City/$tat~/Zip <br /> Owner's Signature: <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br /> Marion County does not rcquir~ a plan r~view, <br /> We will provid~ plan review s~ic~ if YOu comp~t~ <br /> Section 5B and submit two (2) sets of plans and ~ <br /> specifications with this application. <br /> <br />~ L~-34 12~ <br /> <br />PERMIT NO: <br /> <br />Issued by: <br /> <br />4. FEE SCH~,DUL~ (Complete and enter total in Al below) <br /> <br />~ Include: l~ms C~t (each) Su <br />1~ sq, fl. or less $85-~ 4 <br />~ additional 5~ 8q, <br /> or ~ion ~f $15.~ <br />~mimd Energy $20-~ <br /> <br />200 am~ or less <br />~01 amps to 400 al~lps <br /> <br />601 amps to 1000 amps <br /> <br />b) The fee for branch circuits <br /> <br />Each sign or outline lighting <br /> <br />Pack of 10 labels @ $5.00 eaeh <br /> <br />(A~ required by Buildiox Oll~ial) <br /> <br />$50.00 2 <br />$~o,oo 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.iX) <br /> <br />$35.00 <br />$2.~ <br /> <br />$40.00 2 <br />$40.00 , 2 <br /> <br />$40.00 -- 2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />#--of Labels sq.//, x$.bYi = __ <br /> <br />PRES <br />Al, F. mter total of fees from $e~. #4 <br />A2, Add 5% ~ut~ha~ge (,05 x Al) <br /> Subtotal <br /> <br />B. Ent~r 25% of line A 1 ~r Plan Review <br /> (Se~. 3), iF~qui~d <br />~. Inwsfigafion Foe (ifgquired) <br /> <br /> ~T~ ~OU~ DUE <br /> <br />$__ <br /> <br /> <br />