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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 3734427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION /~', : : ~i ~/ <br /> <br />City {Cross St. <br /> <br />Directions <br /> <br />Deacription <br /> <br />PERIvHT$ ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT ] <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Omtractor's License No. ~/~--J~/~ <br />Co,tractor's Board Reg. No. ~..~ I Job No. <br />Si~at~ <br />Su~,isor', LicenseNo. ~~~lph~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (pleaseptJpt) <br /> <br />Mailing A~dr~ss ~ Phone <br /> <br />3. PLAN R~,VIEW SECTIOI',I <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 />b) The fee for branch circuits ~ <br /> purchase of service or feeder fe~ <br />Ftrst branch circuit <br />Each additional branch circuit <br /> <br />E, Mise~llaa~oua (8~rvie~ or F~lae Not lncludM) <br /> <br /> ~ch d~ or outFme li~t~g <br /> Signal cimffi~a) or a limited ener~ <br /> panel, alt~tion or extemi~ <br /> <br /> Over tbe allowabIe in any of~e <br /> <br /> Peek of 10 la~ ~ $5.~ <br /> (s~d oMy to electrical co~ractors) <br />H. Oth~ <br /> (~ required by ~itdi~ OfftcioO <br /> A~ra Dwelling Eleeffical Fee <br /> <br />$35.00 <br />$2.00 <br /> <br />$40.00 2 <br /> <br />$35.00 -- <br />$50.00 <br /> <br /> sq. ft. x $.068 = <br /># of Labels <br /> <br />N/C <br /> <br />:5. FEES Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge 605 x Al) <br /> <br /> D. Reimpectioa Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br /> <br />$__ <br /> <br />$__ <br />$__ <br />$__ <br /> <br />MC 15-341/96 <br /> <br /> <br />