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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br />PERMIT NO: <br /> <br />Date:. <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION '.~ 6 ~. FEE SCHEDULE (Comp]e[eandentcr to[allnAl below) <br />Please complete all Sections, 1 through 5 ' _ _. <br /> .~.~Jkl~ON COU ['~ Residential Per Unit <br /> <br /> BUILDING <br />1. LOCATION OF INSTALLATION <br /> <br /> PROPERTY OWNER ~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractors License No. ~ -- 7 ~l ~ C <br />Contr~torBoardRegSo. -7 q S ~ ~ <br />Supervisor Lic~"Se ~ .~ e~ ~ S <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print) <br />Mailing Address <br /> <br />City, State, Zip <br /> <br /> Number of Inspections per permit allowed <br /> <br />~[~['ln~ee Included: Items ~st <each) gun, <br /> <br /> 1000 sq. ft. or less $85.00 <br /> Each additional 500 sq. ft. <br /> or pofiion thereof S 15.00 <br /> Limited Energy $20.00 <br /> Each Manufactured Home or <br /> Modular Dwelling Service or Fcoder $40.00 <br /> <br /> B. Services or Feeders (Does not include branch circuits, see section D) <br /> <br />purchase of service or feeder fee <br /> / <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. <br /> A2. Add 5% sumharge (.05 x Al) <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.~0) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> Owner's Signatare <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 7/97 <br /> <br />$ <br />$ <br /> <br /> <br />