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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 - Suit~ C <br /> Salem, Oregon 97305-1398 <br /> <br />Office: phone 588-5147 · 4:30pm <br /> <br />PERMIT NO: <br /> <br />Date:. <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete afl Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />TAX ACCOUNT NO. <br /> <br />IJllH 1 <br />~ARION CO <br /> <br />CITy <br /> <br />PROPERTY OWNER <br /> <br />CROSS STREET/ <br />DIRECTIONS <br /> <br />PRO'CT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXp~E IF WORK IS NOT <br />STARTED WITHI~ 180 DAYS OF ISSUANCE OR 1F <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Propelly Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Owne~ 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 ff you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />$15~00 <br />$20.00 I 1 <br /> <br />B, Services or Feeders (Does not include branch circuits, see t~tton D) <br /> <br />htntallalion, Alte~atlon or Reloeatlon <br />200 amps or less I <br />201 amp~ to 400 amps <br /> <br /> . <br /> <br />$35.00 __ 2 <br />$40.110 2 <br />$80.00 2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$50.00 <br /> <br />A i. Enter total of fees from Sec. #4 <br />A2, Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A 1 for Ptan Review <br /> (Sec. 3), if required <br />C. lnvestlgation Fee (if ~equlred) <br />D. Reinspection Fee ($25.00) <br /> <br />R~ceiptNo. <br /> <br />Subtotal <br /> <br />TOTAL AMOI3~ DUB <br /> <br />$ <br />S <br /> <br />MC 15o34 7/~7 <br /> <br /> <br />