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FOR CITY VALIDATION[ <br />Reeelved by: [ <br />Date: I <br /> <br />MARION COUNTY BUILDING INSPBCT~ <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> ~ Hr Inaction L~ <br /> Office: 588-5147 8:~a.m.-4:30p.m. <br /> F~X: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ~11 Sections, I through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABL~ AND EXPIKE IF WORK 18 NOT <br />STARTED WITHIN 180 DAYS CE ISSUANCE OR IF <br /> WORK 18 SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor' I Phone <br />Mailing Addrest¢ <br /> <br />21:1. FOR OWNISR INSTALLATIONB <br /> <br />3. PLAN' REVIEW SECTION <br /> <br />MariOll County does llot require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC? 1.5-.14 12/o4 <br /> <br />4. EH~ ~lCH]~DIJL.]~ (Complete and enter total in Al belowl <br /> <br />A. <br /> R~id~ntial <br /> ~nit <br /> <br />~ch Manufaetu~d Home or Modular <br /> <br />200 amps or I¢~s ~ $~.00 <br />201 amps to ~0 amps $~.00 <br />~ 1 am~ m ~0 amps <br />~1 am~ to 1000 ~pa $130,00 <br /> <br />R~¢Onn¢¢t only $~.00 <br />20I am~a ~ 400 ~a <br /> <br />E, Miscellaneous (Service ce F~ler No~ ln¢lud~l) <br />Each pump or irrigation circle $40,00 -- <br />Each sign or outlMe lightin$ $40.00 -- <br />Signal 0it~uit(a) or a limited energy <br />panel, alteratk, l or extension $40,00 -- <br />F. Each additiomd Inspection <br />Over the allowable in any of thc <br />above~ per lmpeetion $35.00 -- <br />0, Mine* Installation Labels <br />Pack of I0 labels @ $$.00 each $50.00 <br />(sold only to electrical coatl~tctors) <br />H, Other <br />(As reqtticed by Bttilding OPJ¢ial) <br />Aurora Dwelling Electrical <br /> Dwelling Permit Label <br /> <br />2 <br />2 <br /> <br />2 <br /> <br /> __ $q.//. x $.06 = ..... <br /># of Label*____ ~ <br /> <br />FEES <br /> Al. Enter term o£fees f'rom 8¢c. #4 <br />A2, Add 5% sureharg~ (,05 x Al) <br /> Subtotal <br /> <br />B, Enter 23% of lkle A I for Plan Review <br />(Sec. 3), ffrcqulred $. __ <br />C, Investigation Foe (ifeeqoired) $. <br />D. Rein~p¢¢lion Fao ($25.00) $ .... <br /> <br /> TOTAL AMOUNT DUB $~,' <br /> Receipt No. <br /> <br /> <br />