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Received Ely: <br />Date: <br /> <br />F6R CITY VALIDATION <br /> <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 $88-S147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />PERMIT NO: <br /> <br />D~te: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CITY ~,~ <br /> PROPER~ O~R <br /> <br /> CROSS ST~ET/ <br /> DI~CTIO~S <br /> <br /> PE~S ~ NON-~NSFE~LE A~ E~I~ IF WO~ IS NOT <br /> ST~D WI~ 180 DAYS OF ISSUANCE OR · <br /> WO~ IS S~SPE~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR'OWNER INSTALLATIONS <br /> <br />ProperW Owner (pleo~e 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) gets of plans and <br />specifications with this application. <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al ~low) <br /> <br />Installation, Alteration or Relocation <br />200 amps or less <br />201 amps to 400 amps <br />401 ~nps to 600 amps <br /> <br />$50.O0 2 <br />$60.O0 2 <br />$100.00 2 <br />$130.00 2 <br />$300.00 2 <br />$40.00 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$2.o0 <br /> <br />$35.00 <br /> <br />S50.00 <br /> <br />~1. ft, x $.068 = __ <br /> N/C <br /> <br />5. FEES <br /> A 1. En~r total of fees from Sec. #4 <br /> A2. Add 5% sumhat~ (.05 x Al) <br /> <br />B, E~t~ 25% of Vm~ A1 for Plan <br /> (Sec. 3), if required <br />C. Investigation Fee (if requin:d) <br />D. Reinspecfion F ~e ($25.00) <br /> <br />Receipt No. <br /> <br />MC 15.34 7/97 <br /> <br /> <br />