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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. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> t3td ,_ ?/_o-v3-2! <br />1. LOCATION OF INSTALLATION .r <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Cc~tractor'sLiccns~No. ~L/~...~ C~ <br /> <br />Contraclor'sBonrdRe$.No. l{~.~Z,~ I · II JohNo. <br />Signattwe of Supervisuig Electrimml ~~ <br />Supervisor's License No. ~ ~ 1 7 -33o7 <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Property Owner 0J/eas~ print) <br />Mailing Address [ phone <br />City/StetefZip <br />Owner's Signature: <br /> <br />3. PLAN REVIEW 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 15-341/96 <br /> <br />Issued by: <br /> <br />4. FEE SCHHDUL~ (Complele andenter total InA1 below) <br /> <br /> Rex. onneet only $40.00 2 <br /> EaCh branch circuit ~ $ ZOO <br /> <br />b) The fee for branch circuits ~,ithout <br /> pAl~,~aze of service or feedot f~ <br />Ftrst branch circuit <br />Each additional branch circuit <br /> <br />1t. Miseellaneoua (8ervie8 or Feede~ Not Included) <br />Each pump or irrigation circle <br />Each sign or outline li~l~ frog <br />Signal ciccuit(s) or a limited en~' <br />panel, alteration or extension <br />P. Ea~ additional ln~eetion <br />Ov~r the allowable in any of <br />above, p*r Inspection $35,00 <br />O. Min~r lr~stallation Label~ <br />Pack of 10 labels @ $5.00 each $50.00 <br />(sold only to electrODe I coraractors) <br />H. Otbe~ <br /> (As r~quircd by Building OfficisO <br /> Aurora Dwelling Electrical Fee ,vq. fl- x $.068 = <br /> Dwelling Permit Label # of Labcla <br /> <br />$40.OO 2 <br />.~0.00 2 <br /> <br />$40.00 2 <br /> <br />N/C <br /> <br />A2, Add 5% surcharge (,05 x Al) <br /> 8ubtotal $ <br /> <br />B. Enter 25% of line Al for Plan Review <br />(Sec, 3), if requir*d $.__ <br />C. Investigation Fee (if required) $.__ <br />D. Reinspeetion Fee ($25.00) $.__ <br /> <br />P <br /> <br /> <br />