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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 /> Off'ice: phone 588-5147 8:00am - 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> D =ONS <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 />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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />A. Residential Per Unit <br /> Service Included: <br />1000 sq. ft. or]ess <br />Each additional 500 sq. ft. <br /> or portion thereof <br />Limited Energy <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> $85.00 4 <br /> <br /> $15.00 <br /> $20.00 ] <br /> <br /> $40.00 ---- 2 <br /> Services or Feeders (Does not include branch circuits, see section D) <br /> <br />FEES <br />A 1. Enter total of fees from Sec. <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A 1 for Plan Review <br />(Sec. 3). if nXluired $ <br />C. Investigation Fee (if required) $ <br />D. Reinspection Fee ($25.00) $ <br /> ~or^~ A~ou~ DUE $ ~ ~ <br />Receipt No. <br /> <br /> <br />