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MARiOr <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 lnapecfioa Lin~ 588-7904 <br />Offi~: 588-514'/ 8:00n.m.-4:30p.m. <br />FAX: 5887948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all ,Eections, I through <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABL~ AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN l~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPF-NDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />C~actor'sLic~s~No. ~ ~--~ <br />~ac~r's Bo~ Reg. No.~ ~/?~ ] lob No. <br /> <br />2B. FOR owIqBR INSTALLATIONS <br />] Proper~y Owner ~le~pd.,~) <br /> <br />Mailing Address <br /> <br />Ciiy/State/Zip <br /> <br />Owner's Signets: <br /> <br />3. PLANREVIBW SECTION <br /> <br />Phone <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 />Issued by: <br /> <br /> ~bcr of ~fio~ p~ ~R ~ ~ <br /> / <br /> ~d~tial <br /> Unit <br /> 1~ ~t(~h) S~ I <br /> ~ Inoiud~: <br />l~ sq. fi. ~ les~ $~.~ 4 <br /> <br />~ited E~r~ ~0.~ 1 <br />~ch M~facm~ Ho~ or M~ <br /> <br />B. S~ ~ F~s (~ not ~clu~ ~ch ~ui~ a~ a~ti~ D) <br /> <br /> ~ ~ or I~ $~.~ 2 <br /> ~1 ~ to ~ ~ $~.~ 2 <br /> ~1 am~ to ~ ~ $1~.~ 2 <br /> ~1 am~to l~pa $1~.~ 2 <br /> O~r 1~ ~s or ~1~ ~.~ - 2 <br /> ~nneet on~ ~.~ <br /> <br />C. T~p~y <br />Inmn~t~ ~t~at~, ~ R~ti~ <br />~ ~ or le~ $35.~ 2 <br />~t ~to~ ~.~ 2 <br />~1 ~ to ~ ~ $~ 2 <br />~r ~ ~ps or 1~ vol~ <br /> <br /> ~t~at~, ~ R~i~ P~ Phnd <br /> a) ~e fee for ~eh c~ ~ <br /> <br /> ~ch b~nch e~uit $ <br /> <br />b) The fee for blanch circuits without <br /> <br />$35.00 <br />$ 2.00 <br /> <br />E. Mis~ll~n~s (Servle~ er P~ede~ Not Include) <br /> <br /> SiSal civet(s) or a l~il~d <br /> ~n~, alt~ti~ or ex~i~ ~ <br />F. ~ add~l i~mi~ <br /> ~er ~ allowable ~ any Of ~ <br /> ~ve, ~r ~t~n ~5.~ <br /> <br /> ~ck of 10 labels ~ ~.~ ~ch $~.~ <br /> (~d on~ ~ vl~iol co. factor) <br />H. Oth~ <br /> <br /> A~m~ellingEtee~ealF~ . ~. x $.~ = <br /> ~elling Pe~it ~be[ ~ of ~ls <br /> <br />5. FBES Al. Enter ~otsl of fees from Seo. #4 <br /> A2. Add 5% surcharge 605 x Al) <br /> <br />~ubtota! <br /> <br />B. Enter 25% of I~ Al for Plan Rovi~w <br />(Sec. 3). if roquired $.__ <br />C. Investigation Fee (if required) $.__ <br />D. Reimpection Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE $.__ <br />Receipt No. <br /> <br />l~ 15-~4 12/94 <br /> <br /> <br />