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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancast~' Dr. NE - Suite C <br /> Salem, Oregon 97305.1398 <br /> <br /> 24 HR Iml~zflon ~ 373-4427 <br /> Office: i~aone 588-$147 8:00~m - 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 /> D~C~ONS <br /> <br />PROIECT DESCRIPTION <br /> <br />PERMITS ARE NOIq-'I'RAN$1~.RABLE AND EXPIRE IF WORK IS NOr <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />Electrlcal Contractor <br />Mailing Address City <br /> <br />FAX ~. m <br />Contractors License No. m C <br />Comracmr Board Peg No. <br />Supervisor License S <br />Signature of $upv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLAN ~W SECTION <br /> <br /> M~on Coun~ does not ~qui~ a pl~ review. <br /> We w~l provide pl~ ~view ~ice if you complete <br /> S~fion 5B ~d sub~t two,(2) sets of plans and <br /> s~cifications wi~ this app~ca~on. <br /> <br />PERMIT NO: <br /> <br />Da~e:. <br /> <br />Issued by: <br /> <br />Limitea Enemy <br /> <br />4. FEE SCHEDULE (ComCet~ ~md en~ to~ in A1 below) <br /> Numt~' of Impections per permit allowed -~ <br /> <br /> I~ Cost (~ach) Sum / <br /> $85.00 4 <br /> <br /> Stt-dee~ or Feeders (I~es not Indnde branch dtwalta, see section D) <br /> <br />5. FEES <br /> Al. Enter total of fees fwm Sec. #4 <br /> <br />B. En~r 25% of line A1 for Plaq R~view <br /> (Sec. 3), if required <br />C. Investigation Fee (if n:quired) <br />D. Reimpection Fee ($25.00) <br /> <br />ReceiptNo, <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br /> <br />$ <br />$ <br /> <br />MC 15-34 7/~7 <br /> <br /> <br />