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FOR CITY VALIDATION <br />R*ceived by: <br />Date: <br /> <br />MA~ON COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NB · Room 132 <br /> Salem, OR 97301 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all ~ectlons, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issuod by: <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 5885147 8:00am- 4:30pm <br />FAX: $88-7948 <br /> <br /> 4. [~]~1~ SCH][~D~ (C(~nplcte and enter ~tal in Al below) <br /> Number of lmp~tions p~ permit allowed <br /> Rea~demlal <br /> Unh <br /> ~vlce Included: Iten~ ~oat (each) Sum <br /> 10~0 sq. ft. or le~ $85.00 <br /> Rach additional SO0 sq. ft. <br /> or 0ortion ther*of $15.00 <br /> L/mired Energy $20.00 <br /> Each Mamffaetur~d Hom~ or Modular <br /> Dwelling Service or Feeder $40.00 <br /> <br /> B. Services o~ Feeders (Doen not include branch cimuits, see section D) <br /> <br />PERMI'YS ARE HON-'IIIANSFF-P, ABLE AND EXPIR~ IF WOP~ IS NOT <br />STAR'I'E~D WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~qDF, D FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Fax# <br /> <br />Job No. <br /> <br />Property Owner <br /> <br />Contractors License No. <br /> <br />Contracter's Board Reg No, <br /> <br />Signature of Sup*rvis~ng lgl emfiCmn <br /> <br />3. PLANRlgVIEW SECTION <br /> <br />$50.00 <br />$~0.00 <br />$100.00 <br />$130.00 <br />$300,00 <br />$4O.00 <br /> <br />$35,00 <br />$40.00 <br />$80.00 <br /> <br />$ 2.00 <br /> <br />$35.~ <br />$2,~__ <br /> <br />$40.00 2 <br />$4O.OO 2 <br /> <br />$35.00 <br /> <br />$50.~0 <br /> <br /> xq. ft. x $.068 =__ <br />#of Labels N/C <br /> <br /> Marion County does not requite 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-$41/96 <br /> <br />5. TEES <br /> Al. Enlcr total of fees from <br /> A2. Add 5% sufcharg~ (,05 x Al) <br /> ~bt~al <br /> <br /> B. Ent~ 25% of lin~ A 1 for Plan Review <br /> (~. 3). if ~qff~d <br /> C. l~oatigation F~e (if ~q~r~) <br /> D. ~i~pec~n ~ ($25.~) <br /> <br /> ~T~ ~O~ <br /> R~eipt No. <br /> <br />$ <br />$___ <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />