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FOR CITY VALIDATION BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE- Suite C <br />{Received By: ~ ~ [ Salem, O~gon 97305-1398 Da~ <br /> <br />I I 0~: ~ ~-~I~ &~am- 4:$Opm Issued <br /> <br /> ELECTRICAL <br /> PERMIT <br /> APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> T X^CCou Cl I I { I--I I I I <br /> <br /> CROSS <br /> <br />PROJECT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS 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 INSTALLATItNS <br /> <br /> Property Owner (please print) <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 /> specifications with this application. <br /> <br />MC 15-34 7/97 <br /> <br />A, Residential Per Unit Number of Inspections per percnit allowed ~ <br /> Service Included: lter~s Cost (each) Sum <br />[000 sq. ft. or less $85,00 __ 4 <br />Each additional 500 sq. ft. <br /> or porlion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or <br />Modular Dwelling Service or F~eder S40.00 2 <br /> <br />B. Services or Feeders (Does not include branch circuits, see section D) <br /> <br />$60.00 2 <br />$100.00 2 <br />$130.00 2 <br /> <br /> $40.00 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />SSO.~) 2 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />sq, ft:x$.06S =__ <br /> <br />5. FEES Al. Enter total of fees from Sec. it4 <br /> A2. Add S% sumhavge (.05 x Al) <br /> <br />B. Ente~ 25% of lhqe Al for PIml Review <br /> (Sec. 3L if required <br />C. Investigation Fee (ff required) <br />D. Reinspection Fee ($25.0~) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />