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FOR ¢IT¥ V ID^ ONI <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION' <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />?.85 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 H~ l~ect/~n Lin~ <br />Off'~e: 588-5147 8:00 a.m. - 4:30 p.m. <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1, LOCATION OF iNSTALLATION <br /> <br /> PERMITS ARE NON-TRANS P~EP-.~- B Ll~ AND EXPIRE 1~' WORK IS NOT <br /> STARTED WtTHIN 180 DAYS OF ISSUANCgr OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR I~IgTALLATION ON'LY <br /> <br />211. FOR OWNER <br /> <br />Pmpcay Owner (ple~*o pt'iat) <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Sectkm 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />ME? 15-.{4 12.~24 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FtlI;i SCHEDULE (Complete and enter total in Al below) <br /> <br />1~ sq. fi. or less $85,~ <br /> <br /> ~1 ampa to 1000 ~ps $130.00 <br /> <br /> b) ~le the for branch dmulta ~ <br /> ~,~h additional branch ei0~tt~~ $ 2.00 <br /> <br />5. FEES <br /> A I. I~ntq, r tolal of f~es from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />$ <br /> <br /> <br />