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03/14/96 15:17 ~503 588 7D48 ~001 FOR CITY VALIDATION Received by: Date: MARION COUNTY BUILDING INSPBCTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 24 hr. Inspection Line 373-4427 Office: Phoae 588-5147 8:00am-4:30pm FAX: 588-7948 ELECTRICAL PERMIT APPLICATION I Please complete all Sections,. 1 through 5 1. LOCATION OF INSTALLATION PERN~YS AR~ NON~TRANSI~RABLE AND EXPIP.~ IF WORK IS NOT I STARTED WITItlN 180 DAYS OF ISSUANCR OR IF WORK IS SUSPI~DED FOR 180 DAYS. CONTRACTOR INSTALLATION ONLY MniSngAdd~, Iq POR OWNER INSTALLATIONS Owner (please print) Mailing Ad~s City/Stale/Zip Owner's Signature: 3. PLAN REVIEW SRCTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. Date: Issued by: 4. F~]~ SCH~DUI_.~ (Complete and enl~r lotal in Al below) Nmnber of lmpoctio~ R~donfiat ~rvie~ lnoludM: 10~ sq, fl. orless $85,~ 4 ~ch M~acturM H~e or M~ular Dwdling S~ic~ or Feed~ $40,~ 2 B. ~vi~s ~ F~a (~a not inclu~ br~h ciwuit~ s~ aectbn D) ~0 am~ or I~ $50,00 2 201 amps to 4~ ~ps ~.~ Over 1~ amps or voi~ 200 m)l~ or less $~.00 2 ~1 am~ to ~ am~ ~ $~.00 2 D. a) ~ f~ for b~h The fee for Inanch circuits Firat b~meh circuit ~ach addilion~ brach claret $35.0~ ~ S E. Miscellaneous ($e~vieeor'Peed~ Nd lnoluded) ~ pump or ~'i~ttion c~le ~.~ 2 ~ch si~ or outl~e ligb~ng $~.~ ~ 2 P. Eaoh addRio~l ]~t~n Over the allowable in nny 0f the ~ove, ~ b~pe=t~n S35.00 O. Min~ Ina~llnfion Labels Pa~k of 10 labels ~ (~ requi~d by ~tldi~ O~cial) A~ra Dwetli~ Blec~ca[ Fcc ~-~q. $. PEES Al. Emer total of fees ~oin Sec. g4 A2. Add 5% surcharge (.05 x Al) B. ~r25%oflineAl for Plan Re~ow (~. 3). if gquirad C. lnv~tigation Fee (if~quir~) D, Re~peetion ~e TOT~ ~O~ D~ Receipt No.. $. $_ $.