Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Ch~ch St NE · Room 132 PERMIT NO: <br /> FOR CITY VALIDATION Salem, OR 97301 <br /> Received by: <br /> Date: _i~..~ .~ ~t~..t~.~3~. ~,,~~ ~nh,'~ ,.~ne~3.]~/[/? Dsto: <br /> <br /> -., ,, I[ll <br />IELEC 'I'RICALPERMITAPPLICATION [ ,~, I~'Yh <br />Pleasecompleteall Sections, l through $it ARiON ]~.fT]~.l~SCH~DUL~(CompletaandentertolalinAlbelow) <br /> UUILDING I ~d,m' tialPerUait HumberorInspectioaapeepetmkallowed-~ <br /> L LOCATION OF INSTALLATION ~ ~W~laoi~d~d: lt~t~ Co~(~h) Sum <br /> .~ ..... I ~ ! , .., ~ ~ (ffl 1000~q. fl.o~ess $85.00 <br /> <br /> _ $20.00 1 <br /> Dizecdom Dwelling 8exviee or Eaeder $40,00 2 <br /> <br /> B. ~'viee~ or Fe~lers (1)o~ not/n¢lude Iranch ¢ivzui~, see segtlon D) <br /> <br />PERMITS AR~ NON-TRAHSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2B. FOR OWNBR INSTALLATIONS <br />Property Owner ~olea~pdm) <br /> <br />Mailing Adch~ss [ Phone <br />City/State/Zip <br />Owner's Signatm'e: <br /> <br />3. PLAN RBVIBW SBCTION <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 /> 200 amp~ or less $50.00 2 <br /> ~01 aml~ to 400 amps $60.00 2 <br /> 401 Sml~ W 600 nml~ S100.00 2 <br /> 601 amp~ Io 1000 m~s $130.00 2 <br /> <br /> 200 amps or less $35.00 2 <br /> <br /> Each b~anch ch'cait $ 2.~0 <br /> b) '~e fee for Inanch ¢imuits without <br /> <br /> Each pump or irrigation circle $40.00 2 <br /> Each sign or ouffme llg~mg $40,00 2 <br /> <br /> panel, alteration or extenafoa $40.00 2 <br /> <br /> Pack or 10 labels @ $5.00 each $50.00 <br /> <br />H. Othee <br /> (As required by Building O~fcisl) <br /> <br />--,~q. fl. x $.068 <br /> <br />Dwelling Permit Label ff of Labels N/C <br /> <br />FEES <br />Al. Enter totalof fees from Sec. fi4 $ -- <br />A2. Add 5% surcharge (.05 x Al) $ <br /> Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br />(Sec. 3), if required $__ <br />C. Investigation Fee (if required) $__ <br />D. R¢impecfion Fe~ ($25.00) $ -- <br /> TOTAL AMOUNT DUB $7~.(~ <br />Receipt No,. <br /> <br />MC 15-341/96 <br /> <br /> <br />