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MARION COUNTY BUILDING INSPHOIlON <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church SI NE' Room <br />, <br />Receiv~d~b_v: / .OL/I gt.,~/~ Salem, OR 9'/301 <br /> <br />Date: g' 12 ._c/& , <br /> <br /> 24 Hr ln~n~tloa/_.ina: 588-7904 <br /> O~'w~: 588-514'1 8:00 a,m. - 4:30 p.m. <br /> FAX: $88-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br /> Plea$o ¢omplsto ~11 Sections, 10;rough 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />D~cfiptio,'~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 15 NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR 1F <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />Sign~tor~ of Supervising Electrician <br /> <br />2~. ~o~ ow~m~ mrrAtXATIO~S <br />~, Ow.er o,~..,~i,,ooe~oTI, a~, 15 R u me].5 <br /> <br />City/State/Zip <br /> <br />3~ PLANREVIBW $1i~TION <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-$4 12,a~4 <br /> <br />Date: MARION f;au~tw <br /> BUILDING IN,.,~ ~:CTION <br />Issued by: <br /> <br />4. ~qr~E ~ICI'I]:~F}UL]~ (Complete anti ~ m~l ~ Al ~w) <br /> <br />~ch Ma~factu~ H~ne or~u~ <br /> <br /> b) ~ f~ for b~nvh ei~uils wi~ut <br /> ~ch ad&~n~ ~ch e~uit $ 2~ <br /> <br />E. Mis~dlaneaus ($ervlez er F~le~ Nd lflolud~ <br /> ~ pump or <br /> ~ch ai~ or ouflinz li~ting <br /> S~ d~Rs) or a <br /> ~d, ah~ti~ ~m~ <br />F. Ba~ addh~l l~n <br /> ~rt~ nllownble in ~y of~e <br /> <br /> Pack ~ 10 I~ ~ $5.~ ~oh <br /> (~d ~y to e~tri~l <br />H. ~h~ <br /> (~ ~quir~d by ~il~ <br /> A~ Dwelling El~al F~ <br /> ~l~g ~it ~1 <br /> <br />$40.OO 2 <br />$40.00 2 <br /> <br />$4O000 2 <br /> <br />$35.00 .... <br /> <br />$~o.oo , <br /> <br />__~q.~.x$.~6 = <br />#ofLabe~ N/C <br /> <br />5. I~E$ ~ <br /> Al. Emer total of/'~ from S~c.//4 <br /> AZ Add 5% .t,~ha~g~ (.05 x Al) <br /> ~btmal <br /> <br /> B. ~2~ oflin~Al for PlanR~iew <br /> (~. 3), if.q~ ~.~ <br /> C. lnveatignt~ ~ (if~qui~) <br /> D. Reimp~6on Fe~ (~.~) ~ <br /> <br />U'3 <br /> <br /> <br />