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FOR CITY YALIDATIONI <br />Date: <br /> <br />MARION COUNTY <br />iBUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br /> 24 hr. Ia~pecflon Line 3'/3.,442'/ <br />Office: Phone 5~8-5147 8:00am - 4:30pm <br />FAX: 588-?~48 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through <br /> <br />1. LOCATION OF INb'TALIATION <br /> <br /> WO~ ~ SUSP~ FOE I~,DAYS. J <br /> <br />~ CO~CTO~ ~LA~ON O~Y <br /> <br />Con,actor's Board R~g No. <br /> <br />Signalure of Super~isin~ Electrician <br /> <br />j lob No. <br /> <br />211. FOR OWNHR INSTALLATIONS <br />Mailing Add s Ih q l -/22 <br /> <br />3, PLANRBVHIW $1iCTION <br /> <br /> Marion County does not require a plan review. <br />I We will pwvide plan review .service if you complete <br /> Section 5B and subn~it two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-341/96 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FElt SCHli]DIJ'LB (Complete ~ad ease ~o~ b A 1 ~low) <br /> <br /> or ~n ~e~f $15.~ <br />~it~ ~ $20.~ i <br /> <br /> D~ or F~ ~.~ 2 <br /> <br /> a) ~ fee f~ <br /> <br /> F~t b~ch c~t $35 <br /> ~ch ~ddi~d b~eh ci~ffit $ 2.~ <br /> <br />FEE $ <br />A I. Enter Iotal of fee, s fimm Sec. <br />A2. Add 5% surcharge 605 x Al) <br /> <br />B. ~.tcr 25.% of line A t for pla~ Review <br /> (See. 3), if **qult~d <br />C, ~figa~ ~ (if~q~) <br />D. R~pg~a ~ <br /> <br /> ~t <br /> <br />~ubtotal $ <br /> <br /> <br />