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F )R'CiTY VALIDATION <br />IR cciv By: I <br />I te: I <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 /> O~'lCe: phone 588-5147 8:00am - 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />P~S A~ NON-~S~BLE A~ ~ 1F WORK IS NOT <br />ST~D ~ 180 DAYS OF ISSU~CE OR IF <br /> WORK IS SUSPE~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> P~pezty Owrtcr (pJeo~e print) <br /> <br /> Mailing Address <br /> <br /> Cit~, 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: ~t~- 67'et//'//-t/~) <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in At below) <br /> Number of Inspections per permit allowed <br /> <br />Items Cost (each) Sum I <br /> $85,~) __ 4 <br /> <br />$15.00 <br />$20.00 <br /> <br />$35.00 ~ 2 <br />$40.00 2 <br />$80,00 __ 2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />A. Residential Per Unit <br /> Service Included: <br />1000 sq. ft. or less <br />Each addifiooal 500 sq. ft. <br /> <br />Installation, Aaeration or Relocation <br />2C0 amps or less <br />201 amps to 400 amps <br />401 amps to 600 amps <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels ~$5.00 each <br /> (sold only to electrical contractors} <br /> <br />H. Other <br /> (As required by Building Officials) __ <br /> <br />FEES <br /> <br />Subt~al <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if requited <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. -- <br /> <br />$50.00 <br /> <br />N/C <br /> <br />MC 15-34 7/97 <br /> <br /> <br />