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FOP-. <br /> <br />MARION COUNTY:BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Churoh' St NE * Room 132 ',::~:, <br /> Salelal~ OR 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />ARE, NON.TRANSFERABLE AND I~.XPIRE IF WORK IS NOT <br /> <br />STARTED ~qTI'llLN 180 DAYS OF ISSUANCE OR IF <br />WORK 15 SUS~PEND/iD FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />/[lee~ieal Contractor ?/~ Phone <br /> <br />Mailing Add.ss <br /> <br />Property Owner <br /> <br />Conlraetor'a Licenao No, <br /> <br />i <br /> <br />/ob No, <br /> <br />ConR-aetor'a Board Res, NO, <br /> <br />Sup~isor's License No, [ Phon~ <br /> FOR OWNI?.R IlqSTALLATION$ <br /> <br />3_ PLAN RBVIBW 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 />sgecificati, ons with this application. <br /> <br />Line: 588-7904 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />200 anap~ or leas $50,00 <br />20t amp~ to 400 amps $60.00 <br /> <br />~1 am~ to 1000 ~ps $1~,~ <br />Over 10~ a~Bp$ o~ vo]~ $3~,~ <br /> <br /> ~ ~ or leea ~5,~ <br /> <br /> Mi~llan~uo (~vic~ ~ B~ Nm include) <br /> <br /> ~eh ai~ or outline figh~g ~ $~,00 <br /> $~nal eimMt(0 or a limited <br /> <br />5, FEES <br /> Al. Enwr total of revs lmm Sec. #4 <br /> <br /># of Labels ,~ <br /> <br />A2, Add 5% surcharge (,05 x Al) <br /> <br />B. Entec 25% of line A 1 for Plaa Review <br />(Sec, 3), if required $.__ <br />C, Inve~tlgatlon ]Fee (if required) $.~ <br />D, Rei~peetion Fee ($25.~) $,~ <br /> <br />MC 15-34 12/P4 <br /> <br /> <br />