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FOR CITY VALIDATION Received by:. Dato: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 24 hr. Inspection Line 373-4427 Office: Phone 588-5147 8:00am - 4:30pm FAX: 588-7948 ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through 1. LOCATION OF INSTALLATION PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSE~2,1DED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY P~perty Owner I Phone Supervinor'n License No. I Phone 2B. FOR OWNER INSTALLATIONS 3. PLANRBVIEW SECTION Marion CoUnty does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MC 15-34 1/96 Date: Issued by: 4. FI~1~ S~H~DUL~ (~omplete and ~t~ ~ml ~ Al be~w) 1~ ~. fl. ~ less $85.~ 4 ~mited Ene~ $~.~ ~ ~ M~ufactur~ M~ular ~ ~ ~el[ or Feed~ - ~.~ ~1 ~ ~ I~ ~ps $1~.~ 2 ~ 1~ ~ or ~1~ ~.~ ~ 2 R~ect only ~ 2 2~ am~ or 1~ ~5.~ 2 a) ~ fee for bt=ch c~ui~ ~ ~ch branch okuit $ 2.~ ~ b) The fee for branch circuits without First branch circuit Each additional branch circuit $35.00 E. Miscellaneous (Service or Feeder Not Included) Each pump or inigation circle g0.00 -- 2 Each sign or outline lighting $40.00 2 Signal circuit(s) ora llmkd energ~ panel, alteration or extension $40.00 __ 2 F. Each additional Inspection Over the allowable in any of the above, per Inspection $35,00 -- O. Minor Installation Labels Pack of 10 labels ~ $5.00 each $50.00 -- (sold otdy to electrical cot~actors) H. Other (As required by Boiling O~ci~l} Atnora Dwelling Electrical Fee __sq. fi. x $.068 = -- Dwelling Permit Label # of Label~ N/C FEE8 Al. Enl~r mtaloffees from Sec. fi4 $__ A2. Add 5% surchargo (.05 x A 1) $__ ~ubtota] B. ~ter 25~ o~ line Al f~ Plan R~iew (Sec. 3), ~ ~qui~ C. ]~ostigat~n Fee (if ~qui~) D. Re~tion Fee (~5.~) $ ~T~ ~O~ D~ $ . - R~celpt No.