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FOR CITY VALIDATIONI <br />]..'v~ By: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 31 SO Lancaster Dr. NE - Suite C <br /> Salem, Ore~n 97305-1398 <br /> <br /> 24 HR Impecflon Une ~73-4427 <br /> Office: phone ,~88-5147 8:0~am - 4:30pm <br /> FAX ~88-7948 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br /> Serv~ Included: <br />1. LOCATION OF INSTALLATION ~ooo <br /> <br /> I-Inl l I-I lzl I I <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDF~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />PERMIT NO: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete <br /> <br />FAX ~ <br />Coauac~ors License No. <br />Signature of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> M~on County does not r~uim a plm review. <br /> We will ~ovidc pl~ m~ew ~ice if you complete <br /> ~fion 5B md sub~t two (2) sets of plus ~d <br /> s~fficafions wi~ ~is app~cafion. <br /> <br />~h Mimufactt~ed Home or <br />Modular Dwelling Seiwlce or Feeder $4000 <br /> <br />C. <br /> <br />Services or Feeden (Does not include brenda dmplta, see sezttmn D) <br /> <br />Dwelil~g <br /> <br />FEES <br /> <br />$ <br />$ <br />$ <br /> <br />B. Enter 25% of <br /> $ <br />C. Investigation $ <br />D. Reinspection $ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />