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FOR CITY VALIDATION <br />Received by: <br />Date:, <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DI~VELOPMENT CENTER <br />285 Chumh St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 i"[l' Irl~p~x~tion Line: 588-7904 <br />Offle~: 5g$-5147 8:00 a.m. - 4:30 p.m. <br />FAX: §88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br /> PERMITS ARI~ NON-TRANSFERABLE AND EXPIRE IF WOP, K IS NOT <br /> S3~ARTED WITHIN 180 DAYS OF ISSUANCE OR <br /> WORK I~ SUSPF, NDI/D FOR lB0 DAYS, <br /> <br /> 2A. CONTRACTOR INSTALLATION ON]LY <br />! Elcclrical Contractor Ph nc <br /> <br />.215. FOR OWNER ]I~STALLATIONS <br /> <br />Property Owner (pleasepriat) <br /> <br />Mailing Addre~o I Phone <br />Cityl$~lZip <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 />MC L5-34 12/94 <br /> <br />PERMiT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCH~DUL~ (Complete and enter total in Al below) <br /> Number of InsI~¢lions per l~rmit allowed <br />A. <br /> R~idential <br /> Per <br /> Una <br />8~rvlce In¢lud~h Itcm~ Cost (eaoh) Sum <br />[000 sq, R, or leas $§5.00 <br />~aeh additional SO0 aq. it, <br /> or port. ion lher~f $15.00 <br />Limited ~nergy $20,00 <br />Eaeix Manufactured Hot~ or Modular <br /> Dwelling $~rvlca or Feeder $40,00 -- <br /> <br />B, Services or l%eder a (Doea not ine{ud~ brunch ¢ir~u{t~, see section D) <br /> <br />E. Miacellaneou~ (S~tvlee ~r pa~der No{ Inelui~d) <br /> Each pump ~ ~igatlon elg{~ ~ <br /> ~¢h ai~ or outline lighting <br /> Signal ekcuJt(s) of a limited cncr~ <br /> <br />H. Oth~ <br /> (~ ~quimd by ~il~ O~ciaO <br /> <br />$50,00 <br />$C,0.00 <br />$100,00 <br />$1:50.00 <br />$300.00 <br />$40.00 <br /> <br />$35.00 2 <br />$~,00 ~ 2 <br />$8o.oo , 2 <br /> <br />$ <br /> <br />$35.00 __ <br />$ 2.00 __ <br /> <br />$40, <br />$40,00 ~ 2 <br /> <br />$40.00 -- 2 <br /> <br />$35.00 ,, <br /> <br />$50,00 .... <br /> <br /> , ~/.#,x$.0d =__ <br />g of Labels b/lC <br /> <br />5, FEES Al, Enter total of f~es from See, #4 <br /> A2. Add 556 our~harge (,05 x Al) <br /> <br />B, Enter 25% of line A 1 ibr Plan Review <br /> (Sec. 3), if required <br />C, Investigation l~ee (Jfr~qui~d) <br />D, Rein~pcction F~e ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt NO, <br /> <br />$_ <br /> <br /> <br />