Laserfiche WebLink
]FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 255 Chua~h StNE · Room 132. PERMIT NO: <br /> Salem, OR 97301 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />/obAdd~e~s 10647 LEVERMAN <br />c~ AUMS~ILLE ~c~ss s~ <br /> <br /> Date: <br />24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: ~88-7948 ~$U~ by: <br /> <br /> 4. F]~E ~CI'I~}ULE (Complete nnd ~nter lotal in A1 below) <br /> Ntunbar of Inspeofions per peimit nllo~m~d -=~ <br /> Re~ideatial <br /> Unit <br /> ~ervie~ Included: Items Cost (each) Sum <br /> 1000 sq. ft. or lees $85.00 4 <br /> Each edditi~nel 500 sq. ~ <br /> or portion thereof $15.00 <br /> Limited Energy $20.00 1 <br /> Ee~h M~aufectured Home or ~dul~ <br /> Dwelling Set,ice or Fecde~ 1 $40.00 4 0 2 <br /> <br /> B. t~'vice~ or Feeders (Does not include branch circuits, see section D) <br /> <br /> CONTRACTOR INSTALLATION ONLY <br />Eiec~¢mC°a~ac~rXL ELECTRIC IN~ ~ho.e 391 -911 3 <br />MaiFmsAdd~.as 5B1 Lancast~er DR SE STE 50 <br /> <br />~mnY Owner CONKLIN { ~e <br /> <br />Contractor+t~ License No. 24 - 269 C <br />Con~ra¢~or's Board Reg. No. 1 0 9 4 3 2 I ~ob No. <br />$ignetureofSup~rvisingEIectri¢ian//n/.t~, ~ <br />i Supe~viaor'. License No. 2 4 R 1 s I ~n~ 3 ~) 1 -91 1 3 <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (pl~ priat) <br /> <br />Mailing Addr~s I Phone <br />Cit~/Slat~Zip <br />Owner's Signature: <br /> <br />3. PLANREVIEW SECTION <br /> <br /> 200 amps or len~ <br /> <br /> · <br /> Each brauch cit~ult 2 <br /> <br />E. Miscellaneous (~rvie~ or Peed~ Net In~hded) <br /> <br /> ~ach si~n or outline lighting <br /> Signal e~ui~(s) or a limited en ez~' <br /> <br /> Pack of 10 l~ek ~ $5.~ ~h <br /> <br /> (~ r~uired by ~ildi~ O~cial) <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 />MC 15-34 1/96 <br /> <br />$50.00 2 <br />$60.00 2 <br />$100.00 2 <br />$130.00 2 <br />~00.00 2 <br />$40OO 2 <br /> <br />$35.00 -- 2 <br />$40.00 2 <br />$8O,O0 2 <br /> <br />$~.m 4 <br /> <br />zoo <br /> <br />M0.00 2 <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br /> sq. fi. x $.068 =__ <br /># of Labels NIC <br /> <br />5. FEES Al. Enter totaloffees from See. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />~ubtotal <br /> <br />B. Eater 25% of llne Al for Plaa R~view <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinnpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br />$44.00 <br /> <br />$ 46,20 <br /> <br /> <br />