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FOR CITY VALIDATION] <br />R~ceivcd By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone $88-S147 8:00am - 4:30pm <br />FAX $88-7948 <br /> <br />PERMIT NO: <br /> <br />Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. IX)CATION OF INSTALLATION <br /> <br /> CITY <br /> <br /> PROPERTY O~R ] ' <br /> <br /> CROSS <br /> DI~CTIONS ~ ~. <br /> <br /> PE~S ~ NON-~NSFE~LE ~ E~ W WO~ IS NOT <br /> STARED WIT~ 180 DAYS OF ISSUANCE OR <br /> WO~ IS SUSP~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor p~.~ ~-~_. ~ ~.~. <br />Co,=or Bo~d R~g No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, Stzt~ Zip <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 <br /> <br />A. Residential pex Unit Nural~r ° f lnapccfi°na l~r permit allowed ~'~ <br /> Service Included: Peres Cos~ (~h) Sum ] <br />10fi0 sq. tt. or less $85,00 4 <br />Each additional 500 sq. fc <br /> or portion tt~reof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder $40.00 __ 2 <br />B. Services or Feeders (D~es not inclede branch circuit, see ~ctlon D) <br /> <br /> a) The f~ for branch gircuita ~ <br /> <br /> Signal circuit(s) or a limited energy <br /> <br /> (As required by Building Officials) __ <br /> <br /> Dwelling Permit Ladel # of Lasels N/C <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 />FEES <br />Al. Ente~ total of f~es from Sec. #4 <br />A2. Add 5% ~rcharge (.05 x Al) <br /> <br />B. En~r 25% of llne A I for Plan Review <br /> (Sec. 3), if required <br />C. lnve~igation Fee (itrequired) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No, __ <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />MC 15-34 7/97 <br /> <br /> <br />