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FOR CITY VALIDATION <br />IReceived By: ,~~ <br /> <br /> ¢& <br /> BUILDING INSPECTION <br /> 3150 ~caster Dr. ~-Sui~ ~ .~ ~O <br /> Salem, ~gon 97305-1398 l~m' ' ~- Da~: <br /> <br /> ~ ~ I~ Line 373-~ O ~ Issued by: <br /> O~: phone 588-5147 8:~p~ ~' ? ~ <br /> <br />ELECTRICAL PERMIT APPLICATION 4~~et~ aed en~ tot~ in A1 ~low) <br /> <br />P/ease complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> T ACCO O. I?'1 <br /> 770 <br /> <br /> PROP~ O~R <br /> <br /> PROJE~ D~C~ON ~ <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 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br />Mailing Address City <br />Supervisor License S <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLAN ~EW 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 />A. Residential Per Unit <br /> Service Included: <br />1000 sq. ft or inss <br />Each additional 500 sq. fl. <br /> or portion thereof <br /> <br />Each M~nu factured Home or <br />Mod[dar Dwelling Service or Feeder <br /> <br />$85.00 <br /> <br />$t5.00 <br />$20.00 __ I <br /> <br />sq. ft. x $.068 =__ <br /> <br />H. Other <br /> (As required by Building Officials) __ <br /> <br /> Aurora Dwelling Electrical Fee <br /> <br /> Dwelling Permit ILal~el # of Labels __ <br /> <br />5. FEES <br />A 1. Enter ~otal of fees from Sec. g4 <br />A2. Add 5% sm~harge (.05 x Al) <br /> Subtotal <br />B. Enter 25% of llne Al for Plan Review <br />(See. 3), if required <br /> <br /> D. Reinspeeilon Fee ($25.00) <br /> TOTAL AMOUNT DUE <br /> Receipt No. ,~'"~O <br /> <br />$ __ <br /> <br />$ <br />8 <br />$ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />