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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 />MAR.ION COUNTY BUILDING INSPECTION <br /> <br /> PI~RMIT NO: <br /> <br /> D~te: <br /> <br /> Issued by: <br /> <br />24 Hr Inspvctioa Line: 588~7904 <br />Offio,: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON -'I~ANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED V,"/'['I-I J N 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 18(I DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Signatttr¢ of Supervlalng gle~tri~iatl <br /> <br />FOR oWNeR INSTALLATIONS <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 />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />4. FBB/;CHEDULB (Complete and czXtee total in Al b~bw) <br /> <br /> R~id~ntial <br /> Unit <br /> <br />10~ aq- fl. or leas $85.~ 4 <br /> <br />Installation, Alteration or Ro]o~ation <br />200 ampa or less $50.00 ~ 2 <br /> <br /> Fleet branch ¢iv:uit $35,00 -- <br /> <br />Mi~011aneous (Sorrier ex F~er N~ Inclod~) <br /> <br /> Signal ¢i~ult(s) or n limi~d energy <br /> <br />Ea~ additional Insp~tlon <br /> Over t~ al/owab~ ~n any of ~ <br /> <br /> Pack of lO labe]~ ~ $~.00 ~ch <br /> <br /> Oth~ <br /> (~ required by Buildit~ O~eiaO <br /> Au~ra Dwelling Electrical Fee <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$50,00 -- <br /> <br /> ..... ~.d.x$.0~ ~ .... <br />ff of Lab¢ s _~/C .... <br /> <br />B. Enter 25% of llnc Al for Plan Review <br /> (Sec. 3), if ~equiced <br />C. Inveatigation Fac (ifrequirod) <br />D. Reinapection Fee ($25.~) <br /> <br /> TOT~ ~OU~ DUE <br /> Receipt NO, <br /> <br />MC 1,q-34 I2f94 <br /> <br /> <br />