Laserfiche WebLink
FOR CITY VALIDATION1 <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DMSION <br /> 3150 Lancoster 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 ~8-7948 <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 /> lol l-I lbl l l I I I <br /> CROSS ST~ET/ ~ t , I <br /> <br /> PE~ITS ~ NON-T~NS~E A~ E~I~ W WO~ IS NOT. <br /> ST~D ~TH~ lS0 DAYS OF ISSU~CE O~ IF ~ ~ <br /> AYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <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 />4. FEE SCHEDULE (Complete and enter ~otal in A1 below) <br /> <br />A. Residential Per Unit Number of Inapections per pecmit allowed ~ <br />Service Included: Items Coat (each) Sum <br />I000 sq. fi. or less $85.00 __ 4 <br />Each additional 500 sq. ft. <br />or portion thereof $15.00 <br />Limited Energy $20.00 1 <br /> 200Installation,amps or AIterationleas or Relocation O'~ $50.00 <br /> <br /> a) The fee for branch eircuit~ wlth <br /> <br />E. Miacellarteous (Servlce or Feeder Not Included) <br /> <br /> Each sign or outline lighting $40.00 __ 2 <br /> Signal circuit(s) or a limited ~ <br /> <br /> Pack of I 0 labels ~$5.00 each $50.00 <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. 84 $ ~L.~ <br /> <br /> A2. Add 5% surcharge (.05 xA1) $ ~ <br /> Subto~l $ <br /> <br />B. Enter 25% of line A I for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if r~quired) <br />D. Reimpoctlon Fee ($25.00} <br /> <br />Receipt No. <br /> <br /> <br />