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FFOR CITY VALIDATION <br />[Received by: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE * Room <br /> Salem, OR 97301 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> PERMIT NO: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I througl~ 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />24 Hr In~pe.~tJon Line: 58~-7904 <br />Officc: 588-5147 8:00a_m.- 4:30p.m. <br />FAX: 588-7948 <br /> i <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IFWORK IS NOT ] <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOE 180 DAYS- <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2.B. FOR OWNF:~R INSTALLATION5 <br /> <br />City/State/Zip <br /> <br />Owner's Signatu~: <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />[Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 58 and submit two (2) sets of plans and <br /> speciticatkms with this application. <br /> <br />MC1.?-34 12/94 <br /> <br />4. FElt SCHEDULE (Complete and enter Iolal ill Al bch>w) <br /> <br /> P~ <br /> Unit <br /> <br />~01 amps to 1000 mnpa <br /> <br />$5(I.I)0 2 <br />$60.I×) 2 <br />$100.00 2 <br />$130.00 .... 2 <br />$300.00 ........ 2 <br />Sql).()() 2 <br /> <br />$40,00 2 <br />$80.00 2 <br /> <br />$ ZOO ---- <br /> <br />$35,00 <br />$ 2.00 <br /> <br />E, Mi~ellaneous (~ervieo or Feeder Nc~ Included) <br />~ch pump or imga0on circle .... $~).00 ~ 2 <br />~eh sign or oullin~ ligh0ng $~).00 ~ 2 <br />Signal ckeuit(s) or a limited enemy <br /> <br />F. Each additional lasp~tion <br /> <br />G, Min~ Installation ~bo[$ <br /> <br />5. PRES <br /> <br /> A2. Add 5% .~ureharg* 605 x Al) $__~[/LL~_~ <br /> <br /> TOTAL AMOUNT DUE $,,,-3/c,-,/S. <br /> <br /> <br />