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FOR CITY VALIDATION I <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 /> 24 HR Inspection Line 373-4427 <br /> Office: phone 588-5147 g:00am. 4:30pm <br /> FAX 588.7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CROSS S~ET/ <br /> D~ONS <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WlTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (pleale print) <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br />PERIVIIT NO: <br /> <br />Date:. <br /> <br />Issued by: <br /> <br />A. Residential Per Unit <br /> Service Included: <br />i000 sq. ft. or less <br />Each additiomd 500 sq. ft. <br /> <br />Limited Energy <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> NUl~¢~ml ° f I nsl~C2~s(~e~hTmtit allowed q <br /> $85.00 4 <br /> <br /> $15.00 <br /> $20.00 __ 1 <br /> <br />Installation, Alteration or Relaeation <br />200 amps or less $50.00 <br />201 amps to 400 amps $60.00 <br /> <br />Each branch clmuit ~ $2.00 <br /> ¥ ~ <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 />5. FEES <br /> <br />B. Enter 25% of ]i~ A 1 for Plan R~view <br /> (See. 3), if requked <br />C. Investigation Fee (if required) <br />D. Reinspecfion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />s 5-7.7~ <br /> <br />$ <br />$ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />