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FOR CITY VALIDATIONI Received by: Date: MARION COUNTY BUILDING INSpI:t~FION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 24 hr. Inspection Line 3734427 Office: Phone 588-5147 8:00am - 4:30pm FAX: 588-7948 ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 1. LOCATION OF Rq'STALLATION PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED ~ 180 DAYS OF ISSUANCE OR IF WORK IS SUSPF~/DED FOR 180 DAYS. gA. CoITrRACTOR INSTALLATION ONLY 2B. FOR OWNBR INSTALLATIONS Properly Owner Ole~s~ priat) Mailing Addr~s j /q~one ~JtylS tateJZip Owner's Signature: 3. PLANRBVIBW $BCTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. PERMIT NO: Oste: Issued by: 4. F]~]~ SCI-I~UI.~ (Comple~ and enter lotal in A1 below) U~t ~ M~uf~em~ H~ or Mo~l~ T b) The fee for branch cir~uils without purchn~e ofserviea or feeder fee First branch circuit Each additional branch circuit E. Miscellaneous (~vi~ or F~ts Net lnduded) Each pump or inigation circle Each sign or outline lighting Signal circuit(s) or a limited energy panel, alte*ation or extension F. naoh additional lnspeetlon Over the allowable in *n~r of the above, per Inspection O. Minor Installation L~bdm Pack of 10 label~ li~ $5.00 each (sold only to *leetricnl contractor*) H. Other (As r~quirad by Building O~ciM) Aurora Dwelling Ele¢irical Fe~ Dwelling Permit Label $ I00.OO 2 $130.00 2 $3OO.OO 2 $40.O0 2 $35.OO 2 $40.OO 2 $~.~ 2 $ 2.00 -- $35.00 $ 2.00 __ $35.00 $50.00 sq. fi. x $.068 =__ #ofLabe~. N/C 5. BERg A 1. Enter total of fee~ imm See.//4 A2. A&I 5% sweharg~ (.05 x At) Subtotal B. Eoter 25% of t~e Al for Phn Rev~w (~. 3), if ~quir~d C. lnv~tigat~n ~ (if~quimd) D. Re~poe~on Fee ($~.~) ~T~ ~O~ D~ Receipt No.