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1FOR~CITY VALIDATION <br /> Received By: <br /> I <br /> Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr, NE - S~tte C <br /> Salem. Or~gon 97305-1398 <br /> <br /> 24 HR Inspection ~ ~e 373-4427 <br /> Otl'me: phone 588-5147 B:00am - 4:30pm <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> · x^cco No. 17 I/IoI olo <br /> Ill ' i :l <br /> C~TY ~ ~ ~ ~ <br /> <br /> ~.om~o~c~os ~~ ~ ~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED wrrHlN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR ISO DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Ele¢tri¢~ntra¢tor <br />Mailing Addres~ <br />Phone <br />Contractors License <br />Contractor Board Reg~. <br />Supervisor Lic~ <br />Signature of Supv. Electrician <br /> <br />Date: <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> M~ling Add=ss <br /> <br /> City, State, Zip <br /> Iclo I _l-lgl lgl- l / <br /> <br /> M~on Coun~ does not require a plan ~view. <br /> We will provide plan review se~ice if you complete <br /> Section 5B ~d sub~t two (2) sets of plus and <br /> specifications wi~ ~is application. <br /> <br /> Issued by: <br /> <br />4. FEE SCHEDULE (Complet, and enter total in Al b*low) <br /> <br />$85.00 4 <br /> <br />SlS.00 <br />$20.00 1 <br /> <br />B, ServiCes or Feeders (Does not include branch circuits, see section D) <br /> <br />Each branch circuit ~ $2.00 ~e ~. <br /> <br />5. FEES <br /> <br />B. Et~:* 25% of ½ne A1 for Pla~ Review <br /> (Sec. 3), if requil~i <br />C. Investigation Fe~ (if required) <br />D. Reinspectioa Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 7/97 <br /> <br /> <br />