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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />~ T7903 (~R) 1-6-~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />ELECmlCAL PERMIT APPLICATION <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />lob Address 3.~924 Ehl~n ~ <br /> <br />Cross Str~t/Dircainm: <br /> <br /> ~d 2-~ch C~cui~ <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone $88-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br /> ~ial P~ Unit1~ Number o f Inspection~ per pemllt allowed ---~ <br /> ~ Service included:ltenmCo~t (each) Sum <br /> 1000 or less <br /> <br /> mg PF~'[~"~'" th~of $ i s.0o <br /> Each Manufactured Home or Modular <br /> Dwelling S~rviee or Peod~r $40.00 2 <br /> <br /> E. Sm-vieee ~ F~eder s (Doea not i~lude [x~nch ¢i~ui~ ace gearing D) <br /> <br />PF. RIvIITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT { <br /> I <br /> STARTED WI23i]N 180 DAYS OF ISSUANCE OR IF <br /> WORK ]S SUSPEND,ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />ElectHc~Con~actar ELECTRICAL CONSTRUCTION CO. <br /> <br />Address P.O. BOX 10286 <br />rhone~ (503)224-3511 <br /> <br />Property Owner Pacific Telecc~a Phone# <br /> <br />Conuacmr's~rd~g~o. 49737 o. 77903 <br />S~rvisor's ~ No. 2 98 6 S Ph 1 1 <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Prop~y owner do/e~se PH~0 <br /> <br />City/State/Zip <br /> <br />Owner's Signnture: <br /> <br />:3. PLANREVIBW $1~TION <br /> <br />Installation, Alteration or Roloeation <br />601 ampato 1000amps $130.00 __2 <br /> <br />401 mnlm ~o 600 amps $80.00 2 <br /> <br />a) The fee for brnnch ch~ltita ~ <br />Eachbraneheircuit 2 $ 2,00 4.00 <br /> <br />E. MiseeEaneoua (ge~'vi~o or Feeder Not Included) <br /> Each pump or in'igation circle <br /> Each siam or outline lighting <br /> Signal circuit(a) or a limited energy <br /> panel, alteration or extension <br />F. Each additional lnsp~otion <br /> Over th~ allowable in any of tho <br /> above, per ln~pectlon <br />G. Minor Installation Lab~ds <br /> Peek of 10 labels ~ $5.00 each <br /> (so/d only to electdcM ¢omr~ctot~) <br />H. Other <br /> (A~ required by B~ildi~g Og~cisl) <br /> Aurora Dwelling Electrical Fee <br /> Dwelling Permit Label <br /> <br />$35.~ -- <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 2 <br /> <br />$35.00 -- <br /> <br />__sq. fl' x $.068 <br /># of Labels <br /> <br />NYC <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 />5. FEES <br /> A 1. Enter Iotal of tees from Sec.//4 <br /> A2. Add 5% surelmege (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (if required) <br /> D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> 114.00 <br /> <br />S llq_7fl <br /> <br />$.119.70 <br /> <br />MC 15-341~6 <br /> <br /> <br />