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FOR CITY VALIDATION] <br />Received by:__ <br />Date:__ ] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr In~pectlon Line: 588-7904 <br />Off'w,~: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED V~THIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor ~ Phone <br /> <br />Mailing Add~s <br />Pwperty Owner I Phone <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Reg. No. <br /> <br />Signatm~ of Supervising El~triclan <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Pwper~y Owner (ple~epdnt) ~ <br />Mailing Address tO Phoae~ ~'-,~ ~. <br /> <br />3. PLANRBVIBW 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 15-34 12/94 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />qb--.485 <br /> <br />4. NIlE $CHBDULB (Complete and enter total in Al b~inw) <br /> Number of Insl~otions p~r p~rmit allowed ~ <br /> R~d~tial <br /> P~ <br /> Unit <br /> ~vi~ laelud~: lt~ C~t (~eh) S~ <br />1~ sq. fl. or less $85.~ 4 <br /> <br /> or ~n ~of $15.~ <br />L~ited ~ergy $20.~ 1 <br /> <br /> Dwelling Se~i¢e or F~ $~.~ 2 <br /> <br /> ~0 amps or leas ~ $~.~ 2 <br /> ~1 am~ ~ ~ ~ $~.~ 2 <br /> ~1 am~ $1~.~ ~2 <br /> ~1 ~1o l~p~ $130.~ 2 <br /> ~er 1~ amps or vol~ ~.~ 2 <br /> Re,east only ~.~ ~ 2 <br /> <br /> 2~ am~ or 1~ $35.~ 2 <br /> 201 amps ~ ~ ~pa $~.~ ~2 <br /> ~l am~ to ~ ~ $~.~ 2 <br /> ~er ~ ~ps ~ 1~ vol~ <br /> <br />D. ~anoh Cirouita <br /> <br /> a) ~ fee f~ b~ch e~ui~ ~ <br /> <br />b) The fee for branch circuits without <br /> <br />$35.00 -- <br />$2.00 <br /> <br />$35.00 -- <br />$50.00 -- <br /> <br /> sq Ex$.06 =__ <br /># of Labgls NIC <br /> <br /> ~ pump or ~igation cigle <br /> ~ch si~ or outl~e li~g <br /> Si~ c~uit(s) or n I~it~ en~ <br /> <br /> ~er the allowable in ~y of ~e <br /> <br />O. Min~ Ingalintinn Labe~ <br /> ~ck of 10 labels ~ $5.~ ~ch <br /> (s~d o~ly to eloc~icsl c~ractors) <br /> <br /> (~ r~uired by Buil~ O~ciaD <br /> <br />5. FEES <br /> Al. Enter tolal of fees from S~. #4 <br /> A2, Add5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan R~view <br /> (See. 3), if required <br /> C. Inve~tigatinn Fee (if required) <br /> D. Reinspeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. <br /> <br /> <br />