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IFOR CITY VALIDATION <br /> Received By: <br /> <br /> Date: <br /> <br />BUILDING INSPECTION DMSION <br />3150 Lancastc~ Dr. NE - Suite C <br /> Salem, O~gon 97305-1398 <br /> <br />24 HR Inspection Line 373-4427 <br /> <br />Oflic~]~/Iq]l~f~[t]~ 8:00am - 4:30pm <br /> <br />Date: <br /> <br />) ELECTRICAL PERMIT APPLICATION.- I .. I <br /> P/ease complete all Sections, 1 throu'g.~HIE ? ~ ] <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PROJECT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AN~D EXPIRE IF WORK IS NOT <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 prinO <br /> <br /> Mailing Address <br /> <br /> City. Stag, Zip <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 />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al b~low) <br /> <br /> Service Included: <br /> 1000 sq. t~. or less <br />[Each additional 500 sq. <br /> <br />5. FEES <br /> Al. Enter to~ of fc~s f~om Sc~. #4 <br /> A2. Add 5% sumharga (.05 x Al) <br /> <br />B. Enter 25% of linc A l for Plan R~vtew <br /> (Sec. 3), if r~quir~d <br />C. lnve~tlgafion F~ 0 f ~quimd) <br />D. Relnsp~ction Fee ($25.00) <br /> <br />SuNotal <br /> <br />$15.110 <br />$20.00 1 <br /> <br />sq. R. x $.068 = __ <br /> <br />~0 ~2 <br /> 2 <br /> 2 <br /> 2 <br /> 2 <br /> 2 <br /> <br />RecciptNo.__ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />