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F~-0--~ CITY VALIDATION1 <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DMSION <br />2;150 La.caster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />TAX ACCOUNT NO. <br /> <br />JOB ADDRESS ~ <br /> <br />~~IRt~EScSTSI OT NR~sE T / '/~/ . <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT / <br /> STARTED WITHI~I 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Eleeirical Contractor <br /> <br /> Mailing Address City <br /> <br />Contractors License No. <br /> <br />Conlractor Board Reg No. <br /> <br />Supervisor License <br /> <br />Signature of Supv. Electrician <br /> <br />2B. FOR OVgNER INSTALLATIONS <br /> <br /> Propexty Owner(p/ease pr/m) <br /> <br />3. PLAN REVIEW SECTION <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 &plans and <br />specifications with this application. <br /> <br />A. Residential Per Unlt <br /> Service Included: <br /> <br />1000 sq. fi, or less <br />Each additional 500 sq. fi. <br /> or portion thereof <br /> <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder <br /> <br />4. FEE SCHEDULE (Complete and enter total tn Al below) <br /> N;7oxlb~s ° f Inspe~ios°nts(~Trmit ai~d~ <br /> $85.00 4 <br /> <br /> $15.00 <br /> $20.00 I <br /> <br /> $40,00 2 <br /> Services or Feeder~ (Does not include bcanch ~treuite, see s~ction D) <br /> <br />5. FEES <br /> <br />B. Enter 25% of tine A1 for Plan Review <br /> (See. 3), if ~quired <br />C. Investigation Fee (if requi~d) <br />D. Re[nsgaetion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />MC 15-34 7/97 <br /> <br /> <br />