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FOR CITY VALIDATION <br />IReceived By: <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 S88-S147 8:00am - 4:30pm <br /> FAX 588-7945 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> p.m l S'td '1 1 <br /> <br /> CR~S S~/ <br /> D~ONS <br /> <br />PERMYFS ARE NON-TRANSFERABLE AND EXPIRE 1F WORK IS NOT <br />STARTED WITHI~ 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 />PERMIT NO: <br /> <br /> CZ/ <br />4. FEE SCHEDULE (completel~l~..,t)tli6i,l#S~llu <br /> <br />1000 sq. ft, or less <br />Each additional 500 sq. <br /> or portion ~hereof <br />Limited Energy $20.00 <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder [l~ <br /> <br />5. FEES <br />A I. Ellter total of fees from Sec. go, $ <br />A2. Add 5% surcharge ( l05 x Al) $ <br /> Subtotal $ <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 ~$25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 7/97 <br /> <br /> <br />