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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. Inspection Line 373-4427 <br />Office: Phone 588-5147 S:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ~ections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job Descri~*flon: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND F. XPIRE 1F WORK IS NOT <br />STARTED WITHIbT lB0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~/D~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR B~/STALLATION ONLY <br /> <br />Contractor's Board Rea No. <br /> <br />Signature of Supervising Electrician <br /> <br />Supervisor's License No. <br /> <br />2B. FOR OWNER IIqSTALLATION$ <br />Pwperty Owner (plea~ pri~) <br /> <br />]'ob No. <br /> <br />3. PLANREVIE~ SECTION <br /> <br /> Marion County do~s not 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 15-341/96 <br /> <br />4. F]~I~ ~HI~DI. ILI] (ComN~ and ent~ total h A1 b~low) <br /> Number of Ina~tiona ~ ~it allowed <br /> R~id~tial <br /> P~ <br /> Unit <br />~vi~ ine~d~: Ite~ C~I (e~h) Sum <br />l~ 8q, ~. or less $85.~ <br />~ mdd0iona{ 5~ sq. fl. <br /> ~ ~on ~f $15.~ <br />L/m/tod Ene~ $20.~ <br />~ch Ma~facm~ Home or Me'hr <br /> ~eiling <br /> <br />~ ~ ~ P~ ~ nol ~Hu~ ~ch ~im see s~fion D) <br /> <br />200 amp~ or less $35.00 -- <br />201 amps to 400 amps $40.00 <br />401 amps to 600 amps $80.00 <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br /> <br />2 <br /> <br />$35.00 -- <br />$ 2.00 -- <br /> <br />E. Mia~fllan~ous (Service or Feod~ Not inelud~t) <br /> Each pump or in'igalion <br /> ~ si~ or outline li~g $~.~ <br /> Si~nnl circuits) or n limit~ ener~ <br /> <br /> Pack of 10 [abe~ <br /> <br /> (~ required by ~ildi~ O~ciaO <br /> <br />5. FEES <br />Al. Enter total of fees from Sec.//4 <br />A2. Add 5% surcharge (.05 x A 1) $__ <br />Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required $__ <br /> C. Investigation Fee (if required) $__ <br /> D. Reinspeetion Fee ($25,00) $__ <br /> <br /> TOTAL AMOUNT DUE $,__ <br /> R~ceipt No. <br /> <br /> <br />