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FOR CITY VALIDATION <br />R~eived by:~ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr InR~tlon Ling 588-7904 <br />Otfwe: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all ~ections, 1 through <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFF. SLABLE AND EXPIRE IF WORK IS NOT <br />STARTED wrrHIN 1~0 DAYS OF ISSUANC~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> co n cTO <br /> <br />2B. FOR OWNIlR INSTALL&TION$ <br /> <br />Mailing Add~s [ Phone <br />City/State/Zip <br />Owner's Signnture: <br /> <br />3. PLANR~¥1~W SECTION <br /> <br />Ma'ion County does not require a plan review. <br />We wUl 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 />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. ~ ~CHr~DUL~ (Complain and ~ ~ml ~ Al be~w) <br /> <br />I~ ~. ~ or less $85.~ 4 <br /> or ~on ~f $15.~ <br /> <br />C. T~mp~ary ~vi~ <br /> <br />D. Brsn~ Circuits <br /> <br /> a) ~e fee f~ ~ch c~m ~ <br /> <br />b) The fee for branch cimuita without <br /> , <br />~t branch c~rcult <br />I:*ch additional branch circuit <br /> <br /> E. Miseelhn~o~s (~et'vi~ ~- Feeder Net ~) <br /> ~ pump or ~gat~n c~ ~ 2 <br /> ~ si~ or oud~ li~t~g ~.~ 2 <br /> Si~ c~s) ~ a ~ ~ <br /> panct, alle~ti~t or ~t~on ~,~ 2 <br /> <br /> ~v~ ~r ~ct~n ~.~ <br />O. M~ In~l~ti~ ~b~ <br /> ~ck of 10 I~eh ~ ~.~ ~h <br /> (~d only to el~l c~c~) <br />H. <br /> <br />S. FEES Al. Enter total offe~ fiom Sec./~., <br /> A2. Add 5% sumh~ug~ (.05 x Al) <br /> <br />B. Enter 25% of line A l for Plan Revi~t <br />(Sec. 3), if requir~ $.__ <br />C. Investigation Fez (if required) $. <br />D. Reimpection Fee ($~5,00) $. <br /> <br />Receipt No. <br /> <br />MC15.34 12/94 <br /> <br /> <br />