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FOR CITY VALIDATION I <br />Received by:, . <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-S147 8:00am - 4:30pm <br />FAX: ~88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> Please complete ail Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-IRANSFERABLE AND EXPIRE IF WORK I$ NOT [ <br /> STARTED ~rlTHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor I Phone <br /> <br />Mailing Address <br />Property Owner [ Phone <br />Contractor's License No. <br />Contractor's Board Reg. No. I Job No. <br />Signatme of Supervising Electrician <br />Supervisor's License No. t P~one <br /> <br />2B. FOR OWN]RR INSTALLATIONS <br /> <br />3. PLAN REVIItW 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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. I~l~IR SCH~DUL~ (Complete and enter total in Al below) <br /> Number of Inspections p~r permit allowed --~ <br />A. <br /> Re~idemial <br /> Per <br /> Unit <br /> <br />401 aml~ lo 600 amln $80.00 __2 <br /> <br />E. Mi~ellan~ous (Servieoor Feeder No~ include) <br /> ~& pump ~ ~gation c~le <br /> ~& si~ or outl~e li~g <br /> <br /> ~r ~ allowable in any of <br /> <br />O. Min~ ln~a~tion L~els <br /> Pack ~ 10 <br /> (~d oMy to electrical c~ractors) <br /> <br /> A~ra ~elling Elec~cal Fm <br /> <br />$35.~ <br />$2.~__ <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />--~q. fi. x $.068 = <br /># of Labels N/C _ <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec, #4 <br /> A2. Add 5% sumhnrge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter25% of lineAl for PI~ Renew <br /> (~c. 3), if gquimd <br /> C. l~estiga~on ~ (if gquimd) <br /> D. Re.pectin Fee ($~.~) <br /> <br /> ~T~ ~0~ D~ <br /> R~eipt No. <br /> <br />$ <br /> <br />%__ <br />$. <br /> <br />MC 15-341/96 <br /> <br /> <br />