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.FOR CITY VALIDATION[ <br />Received by: I <br />Date: [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITy DF-VELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> ~ Hr Inspotiion Lin~: 588-7904 <br />Off'ge~ 588-:5147 8:00 a.m. - 4:30pan. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRAHSFERABLE AND EXI~RE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANC~E OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Contractor'a License No. ke, ,, <br />! Signntur~ of Supervising Ele~trici <br /> <br />2B. FOR OWHRR INSTALLATIONS <br /> <br />Proper~y Owner (please prim) <br /> <br />Mailing Addre~ [ Phone <br /> <br />city/smc~Z~p <br /> <br />Ovals Signature: : <br /> <br />3. PLANREVIBW 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 />Date: <br /> <br />Issued by: <br /> <br />4. ~ ,'~2H~DUL~ (Complete and enter ~aal in Al below) <br /> Numbor of lnspoetiom per permit allowod ----/ <br /> Resld~tialservlo~ Included:Per Unit Items Co~t (each) Sum[I <br />1000 sq. IL or less $85.00 ~4 <br /> <br /> or poainn am~of $15.00 <br />Limited Enee~ $20.00 J <br />Each Manufactured Home or Modul~' <br /> <br /> 200ankmorle~ f . $50.00 ,,,a~, 2 <br /> <br /> 401 aml~ Io 600 aml~ $100.00 , 2 <br /> 601 ~ ~o 1000 am~ $130.00 2 <br /> <br />C. T~nnporary 8orvior~P~Mors <br />Installation, ~at~, ~ ~t~ <br />~~ $35.~ 2 <br />~1 ~m~ ~.~ .. 2 <br />~l~m~ ~.~ 2 <br /> <br />D. ~a~ <br /> ~, ~at~ ~ E~ P~ Pa~ <br /> a) ~ f~ f~ ~ o~ ~ <br /> ~ of~ of f~ f~ <br /> <br />b) Tho fe~ for In-anch circuits ~ <br /> .nurehaee of service or feeder fee <br />,FInt branch circuit <br />Eae, h additional branch circuit <br /> <br />E. Mbodlaneoua (Servi~ or Feeder Not Ineludad) <br /> · Each pump or irrigation cirgle <br /> Each sign or outline li~laing <br /> Signal ci~uit(s) or a limited energy <br /> <br />F. liaek additional Inapo0tlon <br /> Over the ailowabi~ in any of <br /> <br />O. Minor Installation Labels <br />Pack of 10 labels O $5.00 each <br />(wid ot~ to el~trivf i ~oatr~ctocs) <br />IL Other <br />(A~ roqoir~d by Boi/~qg O~e. iM) <br />Aunxn Dwelling Electrical Fee <br />Dweil/ng Permit Label if of Labels <br /> <br />$35.00 <br />$2.OO <br /> <br />$50.00 <br /> <br />a~. ~. x $.0~ =~ <br /> <br />5. FEB8 <br /> Al. Enter total oft~ from See. #4 <br /> Al. Add :5% sumbrg~ (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (geo. 3), if required <br /> C, lnveetigation Fee (if required) <br /> D, Roinspextion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Roc,~ipt No. <br /> <br />,90? <br />$.~ <br /> <br />$ <br />$.~ <br /> <br />MC 15-34 12/94 <br /> <br /> <br />