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FOR CITY VALIDATION <br />Received by: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · R~)m 132 <br /> Salem, OR 97301 <br /> <br /> 24 br. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Concr actor <br /> <br />Address <br /> <br />Phone// Fax/~ <br /> <br />Pr~o~ny Owner Pho~m~ <br /> <br />[PhoneW <br /> <br />Si}rature of Su~rvisin{ Electrician <br />Su~ervUOr's Liceme No. <br /> <br />2B. FOR OWNllR INSTALLATIONS <br /> <br />3. PLAN REVIBW 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 />specifications with this application. <br /> <br />MC 15-34 1/96 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />b) ~ae fez: for branch circuits <br /> <br />$35.~ <br />S2.00 <br /> <br />E. Miscellaneous (5~rvio~ or Feede~ Not lneluded) <br /> Each pump ~ imgat~n ci~ ~,~ -- 2 <br /> <br /> Si~al c~uit(s) or a I~iled ~ <br /> <br />5. FEES <br /> A 1. Enter It*la] of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Ealer 25% of line A I for Plan Review <br /> (Sec. 3). if required <br /> C. Inv~tignlion Fee (if requited) <br /> D, Reimpe¢lion Fe.~ ($25.00) <br /> <br /> TOTAL AIvlOUNT DUE <br /> Receipt No. <br /> <br /> <br />