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FOR CITY VALIDATION <br />Received <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. 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 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job Address <br /> <br />Cross Stre~Directions: <br /> <br />PERi~gTS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Fax~ <br /> <br />Phone# <br /> <br />No. <br /> <br />Address <br /> <br />Phoneg <br /> <br />Property Owner <br /> <br />ConU'actors Liccns¢ No. <br /> <br />Con~racwr's Board Rog No. <br /> <br />Signature of Supervising Electrician <br /> <br />Supervisor's Li~nse No. ] Phone~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLANRBVIBW 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 /> Date: <br /> <br /> Issu~ by: <br /> <br />4. ~B ~H~ (~mple~ and ent~ to~ Al ~w) <br /> <br /> P~ <br /> Unit <br /> ~vi~ Include: <br /> <br /> or ~on ~e~f $1 <br />Limited Energy $20.~ <br /> <br /> ~c]llng Sc~ice or Fe~ $~.~ <br /> <br />B. 8~vi~a ~ F~a (~ ~t include branch ci~uit~ see sect~n <br /> <br /> 2~ amps or 1~ I $~.~ <br /> 201 a~s to ~ ~ps <br /> ~1 amps to ~ amps $1~.~ <br /> <br /> R~o~ect ~ly $~.~ <br /> <br /> ~)~e fee for b~ch e~ui~ ~ <br /> ~chase o f semice of fee&r fee <br /> ~ch branch <br /> <br />MC 15-34 1/96 <br /> <br />$35.00 -- <br />$2.~ <br /> <br />B. Mbcellaneous (S~rvloo or Foedor Ne~ Included) <br />~ch pump or i~gafion ciwle ~DO 2 <br />~ch si~ or oml~e li~t&g $~.~ 2 <br />Si~al c~t(s) ora l~i~d envy <br />panel, alt~{i~ or extemion $~.~ 2 <br />F. Each additio~l In~ion <br />~er the allowable ~ any <br />a~ve, ~r ~p~tion $35.~ <br />G. Min~ Inhalation ~be~ <br />~ck of 10 labels ~ $5.~ ~ch $~.~ <br />(~d only to cl~t~cz l aom~ctors) <br />H. Oth~ <br />(~ req~rad by ~ildi~ <br /> A~ra Dwelling El~cal F~ ~sq. fl. x $. 068 - <br /> <br />5. FEES <br />A 1. ~nter total of fees from Sec, #4 $ <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. Reinspection Fee ($25.~0) <br /> <br /> TOTAL AMOUNT DUE $,__ <br /> Receipt No. <br /> <br /> <br />