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ELEC - 1466323
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ELEC - 1466323
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Last modified
2/9/2013 1:48:48 PM
Creation date
8/9/2004 2:19:04 PM
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Permits
Permit Address
8792 HOLMQUIST RD SE
Permit City
Aumsville
Permit Number
555-96-07615
Parcel Number
081W31C 00800
Permit Type
ELEC
Permit Doc Type
Permit Document
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cmo VALmATIONI <br />Received by: <br />Date: <br /> <br />MARION COUNTY BLTILDI~G INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />285 Church St NE · Room 132 <br />Salem, OR 97301 <br /> <br /> 24 Hr Inqx~ction Line: 588-7904 <br />Of Iic~ 588-5147 8:00 a.m. - 4:30p.m. <br />FAX: 588~7948 <br /> I <br /> <br />PER/~RTS ARE NON-TRANSFERABLE AND EXPLRE IF WORK IS NOT [ <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br />ElecuiealComractor Judsont s, Inc. I ~one 363-4141 <br />MailingAdd~, PO Box 12669 Salem, OR 97309 <br /> <br />2B. FOR OWN-ER INSTALLATIONS <br /> <br />Owner (pless~ print) <br /> <br />Mailing Addreaa j Phone <br /> <br />Cit~/sm~Zip <br /> <br />Owner's S ign.e.ur~: <br /> <br />3. PLAN RIiVIEW 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 /> s0ecifications with this application. <br /> <br />MC 15-34 12,'94 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FE~ SCH~DUL~ (Complem and en~ total in A1 below) <br /> <br />200 ,raps or le~s g/ $50.00 <br />200 amps or leto $35.00 <br />Each branch ci~uit /~ $ 2.00 <br /> <br />Each sign or outline lighting <br />Signal circuit(s) or a limited energy <br /> <br />$35.00 <br />$ 2.00 <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />__,sq. & .r$.06 =__ <br /># of Labels N/C <br /> <br />5. FEES <br /> A 1. Entar total of f~ea from Sec. #4 <br /> A2. Add 5% su~charg~ (.05 x Al) <br /> Subto¢al <br /> <br /> B. Enter25% of lineAl tbr Plan Review <br /> ($¢¢. 3), if required <br /> C. lnvesligation Fee (i~ r~uimd) <br /> D. Reimpection Fee ($25.~) <br /> <br /> TOT~ ~O~ D~ <br /> Reeeivt <br /> <br />$ <br />$ <br />$__ <br />sgq.oo <br /> <br /> <br />
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