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MARION COUNTY BIfILDING INSPEC~ f~ T~ ~ ~ ~,~ ~ r-.~. <br /> COMMUNITY DEVELOPMENT CENTER I~[~,~.~-'~ <br /> 285 Church St NE, Room 132 I~T <br />FOR CITY V~IDATION Salem, OR 97301 ~ ~ ~ "~ <br />R~iwd by:. Date. ~Uo - <br />Date: ~ Hr Insp~tion Lh~ 58~79~ ' <br /> ,'; %,~ Offi~: 58841'4~ 8]~aam~4:30p.m, MABON COU~TY <br /> <br />Please complete all Sections, 1 through <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br />· c,,, ............. <br />>~t~,~_._~0~. - (~1~ c~ ~ ' ~, <br />.... :~~/~ .~-~ ~. <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />IElectrical Contractor f~.L__~(_[ ~ ~Phone ~,~,,,~:~___[~ ~, <br />/;:.;:,, / <br /> <br /> 2B, FOR OWNI~R INSTALLATIONS <br /> <br /> Pffaperty Owner (pleg$e pz'igt) <br /> M~illng Address I Phone <br /> Cily/StatdZip <br /> <br /> 3. PLANRBVIBW S~{CTION <br /> <br /> Marion Cotlnty does not requite a plan review, <br /> We will provide plan review service it' ynu complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />M~ 15-.~4 12/94 <br /> <br />4. FEE SCHEDULB (ComDlele and enter total in Al below) <br /> <br /> Residential Per UnitNmnbet of Inspeetlons per permit allowed <br /> ~vice Include: ltct~ Cost (each) Sun <br /> <br /> ~0 atnps or le~s $50.00 ~ <br /> <br /> ~1 ampslo 1000 mnps $130.00 ~ <br /> Over 10~ amp~ or volta ~).00 ~ <br /> <br /> 200 amps or leas $35.00 ......... <br /> Owr 6~ ~pa or 10~ volt~ <br /> <br /> u) ~c &c for brmch ci~uim ~ <br /> <br />b) The fee for branch elrcuits kV~II9331 <br /> <br />(As required by &tildltlg Ollicial) <br /> <br />,3s.00 3_~,0'e <br /> 2,00 <br /> <br />$40,00 ---- 2 <br />$40.00 2 <br /> <br />$40.00 ........ 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> ml.#.x$.06 =__ <br /> <br /># of Labels <br /> <br />5. FEIgS <br /> Al. Enter to/alof f¢¢~1 from See, #4 <br /> A2, Add 5% surcharge (.0.~ x Al) <br /> Subtotal <br /> <br /> B I Etltct' 25% of liue A I fi)r Plan Revkw <br /> (See. 3), if required <br /> C. lnveatigatlou Fee (if required) <br /> D. Reinspeetio, Fee <br /> <br /> TOT~ ~OU~ DUE <br /> Receipt No. , <br /> <br /> <br />