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FOR CITY VALIDATION] <br />IReceived By: <br />IDate: <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 8:00am - 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 /> <br /> crrv /~oP-~ <br /> <br /> P.o 161ol. I-Iai vlsl-I -I/ <br /> CROSS STREET/ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIKE IF WORK IS NOT I <br /> STARTED wrrHIN 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 /> 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 />PERMIT NOq~'Oy52~ <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />first baneh ci~uit __J__ $35.00 ~ <br /> <br />panel, aheration or extension ~ $40.00 ~ <br /> <br />5. FEES <br />Al. Enter to~al of fees from Sec. g4 <br />A2. Add 5% sun:ha~ge (.05 x Al) <br /> Subtotal <br />B. Enter 25% of liae Al for Plan Review <br />(Sec. 3), if required <br />C. Investigation Fee (if required) <br />D, Reinspection Fee ($25.OOl <br /> <br />Receipt No,__ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />