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~v. eivedFOR CITY, y: VALIDATION] <br />Date: <br /> <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspe,~ion Line 373-4427 <br />Offwe: phone $88-5147 8:00am - 4:30pm <br />FAX ~794~ <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> c oss I <br /> m oss I <br /> I <br /> p~ ~ ~O~-~SFE~LE A~ E~I~ · WO~ IS <br /> ST~D ~ 180 DAYS OF ISSUAN~ OR ~ <br /> WO~ IS SUSP~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />El¢cuical Contragtor Judson ' s INc. <br />MailingAddr~s P.O. Box 12669 Ci* Salem <br /> <br />Phone 5 0 3 -- 3 6 3 - 4 I 4 1 <br />FAX 5 0 3 -- 3 9 9 -.- ~ 7 6 0 <br /> <br />C~tractors Lieenrz NO. 2 4 m 1 8 C <br />Contractor Board ReS No. 3 ~ 6 0 4 <br />Supervisor ticease i 3 6 9 S <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Mailing Addte~ <br /> <br /> cb. stet~ zip <br /> <br /> Owner's 8ignatu~ <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 7/97 <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complm and,.ae~ ~ in Al below) <br /> <br />Re~tenfial !~' Unlt Numln~ ~f lr%~ In~ genait all°wed -~ <br />Service Included: It~m~ ~ (~a) Sum <br /> <br />$. FEES <br /> Al. Ent~ mud of f~s flora S~. t/4 <br /> A2. Add 5% ~gchar~e (.05 x Al) <br /> <br />D. Reimgecfion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />s <br /> <br /> <br />