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MARION COUNTY BUILDING INSPHCTION <br /> <br /> FOR CITY VALIDATION[ 285 Church St NE · Room 132 PERMIT NO: <br /> Received by:. [ Salem, OR 97101 <br /> 24 Hr In~pe~ioa Li~e: 588-7904 <br /> Office: 588-5147 8:00#.~-;,A~0p.m. -- -- - . <br /> ELECTRICALplease completePERMITall 8octione,AP~l'lOt~r~o~~l <br /> Number of Im~tiom p~r pem~it allowed ~ <br />1. LOCATION OF INSTALLATION A. R~id~ntial P~r Unit <br /> ~ C.~t (each) Sum <br />· ~ P{~ MTXl~evi°~ln°luded: <br />Job Addre~q <br /> <br /> f~,e~.~ Fach Manufncluced Home or Modular <br />Di~¢ti0m ~ ~vollin~ Sarvio0 or Feo~' $40.00 <br /> ?k ~f B. ~vi~ or F~d~r · (Doea not includ~ branch cir~u/ta, se~ ~¢tion D) <br /> <br />Description <br /> <br />PERMITS ARE NON-TRANSFF. RABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANC~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />2Bo <br /> <br />MC 15-34 12./94 <br /> <br /> 1 <br /> 2 <br /> <br /> l~alhtioa, Altm'atioo or <br /> 200 Impa or loss { $~.~ <br /> <br /> ~l am~ to~ ~ $1~ ~2 <br /> ~1 ~ 1~ , $1~.~ ~2 <br /> ~cr 1~ ~ or ~1~ ~ - 2 <br /> ~ only ~.~ ~ 2 <br /> <br />C. T~ary <br /> <br /> ~ ~ or lo~ $3~.~ 2 <br /> ~1 ~ ~ ~ am~ ~ 2 <br /> ~1 ~ps m ~ ~ $ffi.~ 2 <br /> ~ 1~ volta <br /> <br />D. <br /> <br /> a) ~c fee f~ ~ch c~ui~ wi~ <br /> ~bm~uit j ~ $ 2.~ '~ <br /> <br /> Fimt ~ch ~uit ~5.~ <br /> <br />~. M~a~ (~vi~ ~ F~ N~ l~d~) <br /> <br /> ~ ai~ or outli~ ~g ~.~ 2 <br /> S~ c~uit(a) or a limit~ ~ <br /> <br />~ak of 10 laboh ~ $5.~ ~h $~.~ ~ <br />H. 0~ <br />A~ ~olling El~gal Fao ~.~. · x$.~ =~ <br /> <br />A 1. Enter total of t~ea fwm Sec. #4 <br />A2. Add 5% surchqo 605 x A 1) <br /> Subtotal $.__ <br /> <br />B. Enter 25% of lin0 Al for Plan Review <br />(Sec. 3), if required $ <br />C. Investigation Pco (if required) $ -- <br />D. Rein~l~ction Fee ($25.00) <br /> <br /> R~coip~ No. <br /> <br /> <br />