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FOR CITY VALIDATIONI <br />Reeeived by:. <br />Dat~: <br /> <br />. MARION COUNTY <br /> BUILDING INSPECTION DIVISION <br /> 3150 LANCASTER DR NE - SUITE C <br /> SALEM OREGON 97305-1398 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I tl~rougl~ 5 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />2A~ CONTRACTOR INSTALLATION ONLY <br /> <br /> ZB. FOR OWNER INSTALLATIONS <br /> <br /> Mailing Addre~ J <br /> City/State/Zip <br /> <br /> Owner's S ~gnntar~: <br /> <br /> 3. PLANRI~VIBW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review .service ifyou complete <br /> Section 5B and submit two (2) sets o~ plans and <br /> specifications with this applicafion,.~ <br /> <br />MC. 15-341/96 <br /> <br />PERMIT NO: <br /> <br />Daie: <br /> <br />Issued by: <br /> <br /> l~I~ SCH]~)UI~ (Complete and enter total in Al below) <br /> <br />200 amp~ or 1~ il $50.00.~a0, <br /> <br /> purchase of service of feeder fee <br /> F~ch branch circuit $ 2.00 <br /> <br />Each additional branch circuit $ 2.00 -- <br />Packof l0 labels @ $5.00 each $50.00 -- <br /> <br />5. FEES <br /> Al. Enter total of fees from S~c. g4 <br /> A~ Add 5% sur~ha~e (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (S~c. 3), if required <br /> C. lnve. sligation Fee (if required) <br /> D. Reinspe~6on Fe~ ($25.00) <br /> <br /> R~c~'tp t No. <br /> <br /> <br />