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FOR CFrY VALIDATION <br />Received by:_.~ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Chumh StNE · 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 />PERMIT NO: ~ <br />Date: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATIONOFIHSrALLATION <br /> <br />~bAddres~ 945 Olney St. <br />c~ Aumsville [C~ssSr <br /> <br />9th <br /> <br />D~k~ East on Olney St. off Aumsville Hwy. <br /> continue to Blazer. <br /> <br />PERbflTS ARB NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPE~IDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br />EleetriealContraetor Blazer IndustriesI Phone 749-1900 <br />~mm~Ad4~ PO BOX 489 <br />mop~myO~ner Shetler & Shetler I Phone 749-1900 <br />Contractor's License No. 24-197C <br />Contractor's Board Reg. No. 50106 I JohNo. <br /> <br />Supervisor's License No. 3908S I Moa= 749-1900 <br /> <br />2B. FOR OWNI~ INSTALLATIONS <br /> <br /> Property Owner (pl~so prim) <br /> Mailing Address I Phone <br /> Ciiy/S lat~JZJp <br /> Owuer's Signnttu-e: <br /> <br /> 3. PLAN REVIEW 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-$41/96 <br /> <br />4. I~E SCH]RDULH (Complete and eot~ total in A1 below) <br /> <br /> ~vi~ ln~ud~: Ite~ ~t (each) S <br />1~ sq. fl. or less $~.~ 4 <br /> <br />~ch Ma~factu~ H~e or Mo~l~ <br /> <br />B. ~vi~s ~ P~ (~ not include branch ciguRg egg agctbn D) <br /> <br /> ~ amps or less $50.~ 2 <br /> 201 amps to <br /> ~1 amps to ~ am~ $1~.~ 2 <br /> ~1 amps to 10~ ~ps $1~.~ 2 <br /> ~r 1~ amps or vol~ ~.~ 2 <br /> <br /> 2~ ~ps or 1~ $35.~ 2 <br /> ~1 maps to ~ am~ $~.~ 2 <br /> <br />D. Branch Circuit~ <br /> <br /> a) ~ fee f~ brach circui~ <br /> ~m~s¢ of se~ice of f~der <br /> ~ b~nch ci~uit $ 2.~ <br /> <br />$ 2.00 <br /> <br />E. Miscellaneous (Service or Feedm- Hot Included) <br />Each pump or irrigation circle $40.00 2 <br />Each sign or outline lighting $40.00 ' 2 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 2 <br />P. Each additional Insp~:tion <br />Over the allowable in any of the <br />above~ p~r Inspection $35.00 __ <br />O, Minor Installation Labels <br />Pack of 10 labels @ $5.00 each $50.00 -- <br />(sold only to electrical conferrers) <br />H. Other <br />(As required by Building OEiciM) <br /> Aurora Dwelling Elactdcal Fee __sq. fi. x $.068 = -- <br /> Dwelling permit Label ff of Labels N/C <br /> <br />5. FEEg <br />Al. Enter ~mal of fees from Sec. #4 $ <br />A2. Add 5% sumharge (.05 x Al) $ <br /> Subtotal $ q5 <br /> <br />B. Enter 25% of line Al for Plan Review <br />(Sec. 3), if r~quired /~ ~'~-~ - f~-F~ <br />C. Investigation Fee (ifr~quired) <br />D. Reinspection Fee ($25.00) <br /> <br /> _el z~TOTAL AMOUNT DUE $, ~ <br />Receipt No. C/c~r~ ~"1. ~O <br /> <br /> <br />