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FOR CITY VALIDATIONl <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 Inslaecfion Line 373.4427 <br /> Office: phone 588-5147 8:00am - 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> T xAcc°u ND'l I I |l <br /> <br /> CROSS STREET/ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND 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 />I? <br /> <br />I-I ql ,lcq/ <br />I-I <br />I-I/ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Propew/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 />Date:. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> Number of Inspections per permit allov,~l <br />A. Residential Per Unit ] <br /> 1 <br /> Service Included: Items Cost (each) Sum <br />I000 sq. ft. or less $85.00 4 <br /> <br /> 201 amps to 40~ amps $60.00 2 <br /> 401 amps to 600 amps $100.00 2 <br /> 601 amps to t000 amps $130.00 2 <br /> Over 1000 amps or volts $300.00 2 <br /> Reconnect only $40.00 2 <br /> <br />E. Miscellaneous (Servlce or Feeder Not I~duded) ~t~,~2 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. ~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <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 /> <br />