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· FOR~ CITY VALIDATION] <br /> Received By: <br /> <br /> Date: <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 373-44.27 <br /> Office: phone 588-5147 8:00am. 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> · xAcco No, I{_.A t F' tI'51 I l.ol O <br /> <br /> PROPERTY OWNER <br /> <br /> DIRECTIONS <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSU~MNCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address City <br /> <br />FAX ~,. ~ <br />Signature of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> ProperlyOwner(pleaseprint) ~'~t~AJ ~ b~[J~ <br /> Mailing Address t~ ~~ ~6 <br /> City, Sta~,Zip ~~ ~ [~' 0~ ~ <br /> <br />3. PE~ ~V~W SEC~ON <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: ~b <br />Date:. <br /> <br />Issued by: <br /> <br />$85.00 4 <br /> <br />4. FEE SCHEDULE (Complete and emer total in Al below) <br /> <br />A. Realdenflal Per Unit <br />Service Included: <br />1000 sq. ft. or less <br />Each additional 500 sq. ft. <br />or portion thereof $15.C~ <br />Limited Energy $20.00 <br />Each Manufactured Home or <br />Modular Dwelling Secvice--~nelud(DO~ n¢~ I $40.00 <br /> <br />$6o.00 __ 2 <br /> <br />5. FEES <br /> <br />B. Enter 25% of line A1 for Phn Rmview <br /> (Sec. 3), if required <br />C. Investigation Fee (if r~luired) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />sq. ft. x $.068 =__ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />