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FOil CITY VALIDATIONI <br />Receivexl By: <br /> <br />Da~: <br /> <br />BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 58~-5147 8:00am - 4:30pm <br />FAX 58~-7948 <br /> <br />qo d'TS. / <br /> <br />hsued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CROSS S~ET/ ~ <br /> DI~[ONS ~ <br /> PRO.CT DESC~ON <br /> <br />pERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S 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 prin0 <br />Mailing Address <br /> <br />City, State, Zip <br /> <br />Owner's Signature <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 />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> Number of Inai:a~ctiom per permit allowed <br /> <br /> Items Coat (ea~) Sum <br /> $85,00 <br /> <br /> $15.00 <br /> $20.00 <br /> <br />200 amps or less <br />201 amps to 400 amps <br /> <br />Si/mi ¢in:uit(s) or a limited <br /> <br />(As required by Building Offidals) <br /> <br />$50.00 t~ 2 <br />$60.00 2 <br />$100.00 2 <br />$130.00 2 <br />$300.00 2 <br />$40.~0 2 <br /> <br /> $35.00 2 <br /> $40.00 2 <br /> <br />$35.00 <br /> <br />$30.00 <br /> <br />N/C <br /> <br />5. FEES <br /> A I. Enter total of f~s from S~¢. #4 <br /> A2. Add 5% ~mrchatge 605 xAl) <br /> <br />Subtotal <br /> <br />D. Relnspectlon Fee ($25.00) <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br />MC 15-34 7/97 <br /> <br /> <br />