Laserfiche WebLink
FOR CITY VALIDATIONI <br />Reoeived by: I <br />Date: I <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE. Room 132 PERMIT NO: <br /> Salem, OR 97301 <br /> <br /> Date: <br />24 hr. Inspection Line 373.442? <br />Office: Phone .688-5147 8:00am - 4:30pm <br />FAX: 588-7948 Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFF~,ABLE AND EXPIRE IF WORK I$ NOT ~ <br /> I <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNI/R INSTALLATIONS <br />~rop~y O~a~r (please print} <br /> <br />Mailing Address I Phone <br />CitT/S/ate/Z/p <br />Ow t.t.t.t.t.t.t.t.t.t~c's Signature: <br /> <br />3. PLAN REVIEW SBCTION <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. F~ SCH~DU'L~ (Complele and eni~ total ~ Al below) <br /> N~ber of ~cfio~ p~ ~it al~ ~ <br /> R~denthl <br /> Unit <br /> ~lne~d~: lt~ C~t(~h) S~ ~ <br />l~ ~. fl. ~ less $85.~ 4 <br />~ch ad~t~n~ 5~ sq. fL <br /> or ~n ~e~f $15.~ <br /> <br />~ M~ac~ H~e or Modul~ <br />~ei~g Semice or Feed~ ~.~ ~ 2 <br /> <br />B. S~ ~ F~n ~a not include ~ch ei~i~ see se~ D) <br /> <br />b) The fee for branch circuits ~ <br /> purchase of ~rvice or feeder fee <br />First branch circuit <br />Each addi/k~na{ bmooh circuit <br /> <br />$35.00 <br />$ 2.O0 <br /> <br /> sq. fl. x $.068 = <br /># of Labels <br /> <br />E. Miscellaue~ua (8~rvic~ cr F~er Not Include) <br /> ~ pump or ~gation c~,~ t ~.~ q~ <br /> ~ch si~ or outl~e li~g ~.~ ~ 2 <br /> 5i~ c~t(s) or a limited <br /> <br /> ~er ~e allowable ~ ~y of ~e <br /> a~w, per ~pe~n $35.~ <br /> <br /> Pack of 10 labels ~ $5.~ ~ch $~.~ <br /> <br />H. ~h~ <br /> <br />A 1. Enter total of fees from See.//4 <br />A2. Add 555 sumharge (.05 x Al) <br /> fi~lbtotal $.__ <br /> <br />B. Enter 25% of line A1 for Plan Review <br />(See, 3), if r~quited $.__ <br />C. Investigation Fee (if required) $.__ <br />D. R~inspeetion Fee ($25.00) $.__ <br /> TOTAL AMOUNT DUE $ ~ <br />Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br /> <br />