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I;FOR ~CITY VALIDATION1 <br /> eceived By: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Insl~'fion Line 373-4427 <br /> Office: phone 588-5147 8:00am - 4:30pm <br /> FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ,o ,D SS 7 g¥ mitt <br /> <br /> oNEI I I I-III I I I <br /> <br /> PROJECTDESCRIFTION /OD/q ~/.d~dt'O-- ~ ~e° ~t4~ma <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED 'WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> Ma/ling Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />A. Residential Per Unit <br /> Service Included: <br />1000 sq, E, or less <br />Each additional 500 sq. ft. <br /> or portion thereof <br />Limited Energy <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder <br /> <br />$85.00 4 <br /> <br />$15.00 <br />$20.OO I <br /> <br /> Installation, Alteration or Relocation } <br /> 200 amps or less · $50.00 <br /> 201 araps to 400 amps $60.00 <br /> 401 amps to 600 amps $100.00 <br /> <br />E. Miscellaneous (Service or Feeder Not I~iluded) <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 />MC 15-34 7/97 <br /> <br />5. FEES <br /> <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (S,c. 3), if required <br />C. Investigation Fee (if required) <br />D. Relnspeetion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />