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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DIVISION <br />315o Lanczste~ Dr. NE - Suite C <br /> Salem, Oregon 97305-! 398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone $88-$147 8:00am - 4:30pm <br />FAX $88-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ,O.^DDREs. s 116, q l . <br /> <br /> L lo I 1-17 I lq I-Y I <br /> CROSS ST~ET/~_/~ <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 />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please prinO <br />Mailing Address <br /> <br />City, State, Zip <br /> <br />Owner's Signatore <br /> <br />3. PLAN REVIEW 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 />Date: <br /> <br />Issued by: <br /> <br />I A, Residential Per Unit <br />Service Included: <br />1000 sq. ~. or leas $85.00 <br />Each additional 500 sq. ft, <br /> or por6on ~hereof $15.00 <br />Limlt~d Energy $20.00 <br />Each Manufactured Home or <br />M~dular Dwelling Service or Fee~r $40.00 <br /> <br />4. FEE SCHEDULE (Complet~ and enter total in Al b~low) <br /> <br /> 4 <br /> <br />B. Services or Feeders qDoe~ not includ~ br~nch circuits, s~e section D) <br /> <br />Installation, Alterafioa or Relocation <br />200 amps or less $50.00 2 <br /> <br />FEES <br />Al. Enter to~d of fees from S~. #4 <br />A2. Add//% surcha~e (.05 x Al ) <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if reqair~t <br />C. investigation Fe~ (ifrequ~d) <br />D. Relnsgection Fee ($25.00) <br /> <br />Receipt No, <br /> <br />$ 4o.ov <br /> <br />Subtotal $ <br /> <br />$ <br />$ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />