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IReceived By: <br />Date: <br /> <br />FOR CITY VALIDATION <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 588-5147 8:O0am - 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> JOU ~mv~ss q It q O I ~ ~ <br /> <br /> PROP~TY OW~ ~ <br /> <br /> CROSS S~/ <br /> D~ONS <br /> <br />PROJECT DESCRIPTION <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 1BO DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <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 />PE IT <br /> <br />Date: <br /> <br />hsued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> $85.0O __ 4 <br /> <br /> $15,0O <br /> $20.00 __ l <br /> <br /> $40.00 __ 2 <br /> <br /> Services or Feeders (Do~ not include branch elrcults, s~ s~etion D) <br /> <br />200 amI~ or less ~ $50.00 <br />Each branch circuit ~_O $2.00 <br /> <br />5. FEES <br /> A I, Enter total of fe~s from Sec./?4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />$ IqO.oO <br />$ 7,00 <br />$ tqT,~ <br /> <br /> $ <br /> $ <br /> $ <br />TOTAL AMOUNT DUE $ t t~7 * 00. <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee {ff required) <br />D. Reinspection Fe~ ($25.00) <br /> <br />Receipt No. <br /> <br />MC 15-34 7/97 <br /> <br /> <br />