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FOR CITY VALIDATIONI <br />R~oeived by:. <br />D~to: <br /> <br />MARION COUNTY BUILDING INSPBCTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 37~1427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: $88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF IHSTALLATION <br /> <br /> ~ ~ 1 ~ DAYS OF I~SU~ OR WO~ 1~ SUSP~ FOR 1~ DAYS. <br /> <br />~. CO~CTOR ~ATION O~Y <br /> <br />Addrr~s <br /> <br />Phon~ <br /> <br />Fax~ <br /> <br />Phone~ <br /> <br />Pro~r~ 0w~r <br /> <br />lob No. <br /> <br />] Phone~ i <br /> <br />3. PLANRBVIBW 81~.-i'ION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> S~ction liB and submit t~vo (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-341/96 <br /> <br /> r <br />PERMIT NO: <br /> <br />D~te: <br /> <br />Issued by: <br /> <br />4. FEll 8CI-IRr~UL~ (Comple~ and em~ ~1 <br /> <br />~ R~d~ial ~ U~ <br />~ In~d~: lta~ ~t (e~h) <br />1~ sq. t. ~ I~ $85.~ 4 <br />~ ~ 5~ ~. ft. <br /> or ~n &e~f <br />~miied ~ ~0,~ 1 <br />~ M~fac~ H~o or ~1~ <br /> ~8 ~iee or Fe~ ~,~ 2 <br /> <br />B. ~ ~ F~s ~ ~ ~l~e ~ch oi~uit~ see a~ D) <br /> <br /> Reconnect only <br /> <br />E. Miscellaneous (S~'v{o~ ~r F~l~r Ne~ ~lud~) <br /> <br /> ~ si~ or ou~e li~ <br /> Si~d c~t(s) or a ~i~ ~ <br /> <br /> ~ve, ~ ~ion <br /> <br /> Pack of 10 i~h ~ ~ ~h <br /> <br /> (~ ~qui~d by ~il~ 0~0 <br /> <br />$50.00 2 <br />$60.00 2 <br />$100.00 2 <br />$130.00 2 <br />I300.00 __ 2 <br /> <br />$35.~ 2 <br />$40~ 2 <br />$~ 2 <br /> <br />$ 2.00 <br /> <br />$ 2.OO <br /> <br />$35.00 <br /> <br /> sq. ft. x $,068 = -- <br /># Of Labels. N/C _ <br /> <br />A 1. Enter total of fees from See. <br />A2. Add 5% sumharge (.05 x Al) <br /> <br />~b~al <br /> <br />B. Eater25% of lineAl for PlanRoVJew <br /> (Sec. 3), if required <br />C. Investigation Fee (if tequila) <br />D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />