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Received by: <br />Datv: <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 Inspection Line: 588-7904 <br />Off.lee: 588-5147 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through <br /> <br />~^d__ 9/~~reek~d'~6 <br /> <br /> Aumsville ICmsa st. Main <br />C~ <br /> <br />D~ Windemere Meadows <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Ele0triealC~actor B. Warrington I l~.e 585-5889 <br />Maili~^dd~s 3760 Market St NE #311Salem <br />PmpenyOwne~ ila~m Tiny Hans~r~hon~ 7492337 <br /> <br /> 24-334-C <br />Contractor's License No, <br /> <br />Conh-actor's Board Rcg. No. I 04529~ I Job No. <br />Sigaatur~ of Supervising Electrician /(/ ~]~t~ <br />Sup~rvi~r'sLi¢¢nsel~. 4003-;'' I [~a~ .... 585--~ ~-~5889 <br /> <br /> FOR O~,R INSTALLATION8 <br />I'~peny Os, ncr (pleasepdnt) <br /> <br />Mailing Address ) Phone <br />City/State/Zip <br />Owner's Signature: <br /> <br />PLAN RBVIBW 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 />mssu~ b~ABION OOUNIY~.. <br /> BuiLDING ~PEC, Tiui~ <br /> <br />FRB SCHEDULE (Complete and enter total in Al below) <br /> <br />200 amp~ or less $50.00 -- <br />200 amps or less $35.06 <br /> <br />b) The fee fo~ ~anch circuits without <br />vurehase of service or feeder fe~ <br /> 5 <br /> 0 <br /> 0 <br />Fkst branch ~ircuit $35.00D * <br />Each additional branch ~ireult $ 2.00 <br /> <br />B. Miseelinneou$ (Service ~ Feede~ No~ Inelud~l) <br /> ~ch pump or ~gali~ <br /> ~ch si~ or out~ !i~t~g <br /> Si~al c~uit(s) ora limited en~ <br /> panel, alt ~ation or exte~ion <br />P. ~a~ addltin~l Ink,ion <br /> ~er t~ allowable <br /> <br /> ~ck of 10 I~ls <br /> <br /> (~ required by ~ildi~ O~ciaO <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 -- <br /> <br />__~q. fl. x $.06 =__ <br /># of Labels. N/C <br /> <br />FEB$ <br />Al. Enter total of fees from Sec. fi4 <br />A2. Add5% surcharge (.05 x Al) <br /> ~ubtotal <br /> <br />B. Enter 25% of line A 1 for Plan Roview <br /> (Sec. 3), if required <br />C. Investigation Fee (if~exluired) <br />D. Reitmpection Fe~ ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ 35.00 <br />$ I .75 <br /> <br />MC 15-34 12/94 <br /> <br /> <br />