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FOR CITY VSLII~TeI~ON ] <br /> <br />BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR lmp~etion Line 3734427 <br />Office: phone .~8-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br />~L OCATION DE INsTALLATiON <br /> <br /> CITY I~LLgqt/til '~' <br /> <br /> PROPERTY OWNER <br /> <br />I PROJECT DESCRIPTION - ~ <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF ~ORK IS I~T <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Eleeltical Contractor <br />Mailing Address City <br /> <br />Phone -~ <br />FAX ~ '" <br />Cona'actom License No. '" C <br />Contractor Board Rcg No. <br />Supervisor License S <br />Signature of Supv. Electrician <br /> <br />( B.~OR OWNER INSTALLATIONS <br /> <br /> 3. PL~ ~EW 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 />MC 15-34 7/97 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4' FEE SCHEDULE (Complete and enter total tn Al below) <br /> <br />A. Residential P~r Unit <br />Service Included: <br />1000 ~q. lt. or less $85,00 <br /> <br />4 <br /> <br /> $60.00 2 <br /> <br />$300.00 2 <br />$40.00 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />sq.R.x$.068 = __ <br /> <br />5. FEES <br /> Al. Enter toI.~! off~s from Set:. #4 <br /> 32. Add 5% sumh~g~ (,05 x Al) <br /> <br />B. Enter 25% of lin~ Al for Plan Review <br /> (Sec. 3), if required <br /> <br />toss . <br /> <br /> <br />