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FOR CITY VALIDATION[ <br />Received by: <br />D~te: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />~4 hr. Inspection Line 373-4427 <br />omce: Phoae 588-5147 $:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF [HSTALLATIOH <br /> <br /> /!q 'g .)den 4D ..cE. <br /> <br /> ~S A~ NON-~S~B~ AND ~1~ IF WO~ IS N~ <br /> ~ ~ I~ DAYS OF ISSU~ OR IF <br /> WO~ I$ SUS~D~ FOR 1~ DAYS. <br /> <br />~ CO~CTOR ~LATION O~Y <br /> <br />Addre~8 <br /> <br />Conu-actor's Board Rg~ No. <br /> <br />Signature of Su[~.tvisi~ Electrician <br /> <br />Job No. <br /> <br />FOR OWNI]R IlqffrALLATIONS <br /> <br /> 1 <br /> <br />3. PLAN RBYU~W 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 />PERMIT NO: <br /> <br />Date: <br /> <br />issued by: <br /> <br />4. Fi~ SCHBDULI~ (C~xnplele at~d enler Iolal in A I bel~0 <br /> <br />a) T~ fee fox branch circui~ with <br /> <br />h) The {ee for branch cimuita without <br /> <br />Fimt branch circuit <br />Each addihonal branch circuit <br /> <br />$60,OO = 2 <br />$100.00 2 <br />Sl30.OO 2 <br />$3OO.OO 2 <br />M0.OO 2 <br /> <br />2 <br />2 <br />2 <br /> <br />C~ $ 2.OO <br /> <br />$35.U0 <br />$ 2.OO <br /> <br />E. Miaodlaneous (~ervleeof Feeder Iq~ Induded) <br /> Each pump c~ imgation circle <br /> Each sign o~ outline libeling <br /> Signal ¢iocui~(s) ota limit~l <br /> panel, aheration or exlet~ion <br /> <br /> Over the ~llowabie in any of <br /> above, per In~'tion <br /> <br /> Pack of 10 labels O $5,00 each <br /> <br />H. O~h~r <br /> fas r~gm,%'~ by Bmld~r~ Ol~l) <br /> <br /> I:~etiing Peemit Label <br /> <br />$40.OO 2 <br />MO.OO 2 <br /> <br />$40.00 ~ 2 <br /> <br />$35.O0 <br /> <br />$50.00 <br /> <br />--zqft ~$068=__ <br /># of Labele N/C <br /> <br />5. FEE8 Al. F~nler Iotal of feea from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />8ubto~l <br /> <br />B. F~l~r 25% of line A I for Plan Review <br /> (Sec. 3), if required <br />C. Inve~ligatirm F~e (if required) <br />D. R~im~a Fee (~.~) <br /> <br /> ~T~ ~OU~ DU~ <br /> <br />MC 15-34 1/96 <br /> <br /> <br />