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FOR CITY VALIDATION[ Received by: Date: MARION COUNTY BUILDING INSPRCTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 PERMIT NO: Salem, OR 97301 Date: 24 hr. Inspection Line 373-4427 Off'me: Phone 588-5147 8:0~am - 4:30pm FAX: ~88-79~8 [Ssusd by: ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 1. LOCATION OF INSTALLATION WO~ 18 S USP~ FOR CONTRACTOR INSTALLATION ONLY Elecaioal Comractor I Phone Mailing Address JobNo. Conoac~'s Board Reg, No. Siguature of 5ui~rvising Electrician 2B. FOR OWNrlR INSTALLATIONS 3. PLANRBVIEW SBCTION JMarion County does not require a plan review. We will pwvide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MC 15-341/96 Recormect only 200 amps or 1~ a) The fee for branch circuits ~JJh E~ch branch circuit ,~ b) Th~ f~ f~ btan~a ~ttcuits wi~t I $ o.oo $60.00 2 $100.00 2 $130,00 2 $300.OO 2 $40.OO 2 $35.00 2 $80.00 2 $2.00 $35.00 $2.~ E. Mise~laneoua (~erviez er Fzede¢ Not ineluded) ~ch p~p ~ ~gal~n c~le ~.~ 2 ~ si~ or ~ li~g ~,~ 2 ~al, ~fi~ or e~ ~;~ 2 ~r ~ allowable ~ any ~ ~e ~e, ~r ~e~ $35.~ O. M~ ~a~t~n ~ (~d ~yto el~i~l c~cto~) H. ~ (~ wquked by ~il~ O&itO A~m ~lli~ glo.cai F~ sq. fl. x $. 068 = ~ ~l~g ~ ~ g of ~ N~ 5. FEES Al. Enter total of fees from Sec. A2. Add5% sm'charge(.05 xAl) B. Enter 25% of line A1 for Plan R~vlew C. lnv~tigation ~ (ifr~quimd) $ D. Reimpeetion F~ ($25.00) $ mT~ ~O~ D~ S 5~~ R~=ipt No.