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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DMSION <br />3150 Lanc~s~r Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373.4427 <br />Office: phone ~88-$147 8:00am - 4:30pm <br />FAX ~8-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PROPERTY OW~a~REO/~ ~ ~-g /(~ e ~ Z/' <br />THo I-I I-I <br />CROSS S~ET/ <br />DI~IONS <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR 11: <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please prim) <br /> <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 />I specifications with this application. <br /> <br />PERMITNO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complele and en~r rata! in A1 below) <br /> <br />200 amps ~r l~s <br /> <br />Each branch cimuit <br /> <br />5. FEES <br />Al. £nter total of fees flora See. 84 <br />A2. Add 5% su~hm~ (,05 x Al) <br /> Subtoad <br />B. Enter 25% of line Al for PI~ R~evlew <br />(Sec. 3), if r~luir~l <br />C. Inv~tigafion F~ (if mqulmd) <br />D. Reinapeclinn Fee ($25.00) <br /> TOTAL <br /> AMOUNT <br /> <br />MC 15-34 7/97 <br /> <br /> <br />