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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <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 $:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />MARION COUNTY BUILDING INSPHCTION <br /> <br /> PERMff NO: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFeRABLE AND EXPIRE 1P WORK IS NOT <br />STARTBD ~ 1~0 DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPENDED FOR 1~0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION OHLY <br /> <br />2B. FOR OW'NBR INSTALLATIONS <br /> <br />Property Owner (p~ print) <br /> <br />Mailing Address j Phon~ <br />City/State/Zip <br />Owner's Signature: <br /> <br />3. PLANRBVIEW SBCTION <br /> <br />Marion County does 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 />4. FEB ~CHEDULIt (Completa snd e~e~ Iota[ ~ Al ~w) <br /> <br />~ R~dential P~ U~t N~ber of ~ofio~ p~ ~it albw~ ~ <br />~ in~d~: I~ ~mt (e~h) S~ <br />1~ ~, fl. ~ I~s $85.~ ,4 <br />~ch s~l ~ sq. ft <br /> ~ ~ ~f $15.~ <br />~mit~ ~r~ ~0.~ 1 <br /> <br /> ~ll~ Se~i*e or ~ed~ ~0.~ <br /> <br />B. ~v~ ~ F~a ~s ~t ~clud* ~ch ~imult~ *~ s~t~ D) <br /> l~alhtlon, ~t~ati~ ~ ~ti~ I <br /> ~m~orl~ ~ ~.~ ~. 2 <br /> ~ 1 ~m~ m ~ ~ ~.~ 2 <br /> ~1 am~ m ~ a~ St~ <br /> ~1 am~ m 1~ ~ $1~.~ 2 <br /> ~r 1~ ~ or vol~ ~.~ 2 <br /> R~m~ct only ~.~ 2 <br /> <br /> ~lhti~, ~ati~ ~ <br /> ~ ~ ~ 1~ $35.~ 2 <br /> ~1 ~o~ ~ 2 <br /> ~1 m~ to ~ ~ $ffi.~ 2 <br /> Over ~ ~pe or 1~ ml~ <br /> <br />D. <br /> <br /> a) ~ f~ for b~h e~ui~ ~ <br /> ~ b~n~ ~keuit $ 2.~ <br /> <br />$35.00 <br />$ 2.O0 <br /> <br /> sq. ft. x $,068 = <br /># of Labels <br /> <br />B. Mi~ll~a~oua (Service or Foedet' N~ I~) ~.~ ~ ~2 <br /> ~ch p~p ~ ~gat~n c~le [ <br /> ~eh si~ or outline li~g ~.~ 2 <br /> Sign8 e~uR(s) or · I~it~ en~ <br /> <br />F. Bach additioml i~n <br /> Over ~* n~owablc ~ ~ny of ~e <br /> ~ve, ~ ~p~tion ~5.~ <br />O. Min~ In~l~[ion <br /> Pack of 10 labah ~ $5.~ ~h $~.~ <br /> (~d only to el~t~M co, rectors) <br />H. Oth~ <br /> (~ r~oi~d by ~il~ O~w~l) <br /> Arum Dwelli~ El~eal F~ <br /> ~dling P*~it ~bel <br /> <br />5. FBBS <br /> Al. Enter total of fees from See. g4 <br /> A2. Add 5% sutehargo (.05 x Al) <br /> Subtatal $.__ <br /> <br /> B. ~t~ 25~ of line A 1 for Plan ~view <br /> (Sec. 3), if~d $ <br /> C. ~v~figa~n ~ (ifmqu~d) $.__ <br /> D. Re~peetlon Fee ($~.~) $.~ <br /> <br /> ~ccipt <br /> <br />MC 15-341/96 <br /> <br /> <br />