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IFQR ~ITY VALIDATION <br /> i~cd 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 />T DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR 1F <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLA~ )NS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <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 of plans and <br /> specifications with this application. <br /> <br />MC 15-34 7/97 <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster 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 /> 4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> A. Residential Per UoitNumber of lnspections per permit allowed ~ <br /> Servlee Inetaded: Pems Cost (each) Sum <br /> 1000 sq. ~ or less $85.00 <br /> Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br /> Limited Energy $20.00 __ 1 <br /> <br /> Each bt anch cL, x:uit ~ $2.00 <br /> ! <br /> <br />Date: <br /> <br />Issued by: <br /> <br />5. FEES <br /> <br />B. Ent~r 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.~) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DLFE <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />$ <br /> <br />$ L"-o <br /> <br /> <br />