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1W~ON COUNTY <br />' [F(~R CITY VALIDATIONI BUILDING INSPECTION DIVISION <br /> I_ __ _ I 3150 Lancaster Dr. NE - Suite C <br /> IRece~vea t~y: __ I . Salem, Oregon 97305-1398 Date:__ <br /> <br /> ELECTRICAL PERMIT APPLICA'I'I~I I~al~ - 9 ',! ~ -- <br /> · 1'14~ c~4~ FEE SCHEDULE (Complete and enter total in Al below) <br /> Please complete all Sections, 1 through 5.._l~ Number of taspoctions pot poralit allowed~ <br /> -- m0N c0UN r?- Residential PerUnit <br /> ...... Service Included: Items Cost(each) Sum ] <br /> 1. LOCATION OF INSTALLATION BUILDING INSPE( Tt0b~q. ft. or less $g5.00 4 <br /> <br /> TAX ACCOUNT NO~ <br /> JOB ADDRESS ~ <br /> CITY ' <br />~PROPERTY OWNER <br />CROSS STREET/ <br />DIRECTIONS <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR/F 1 <br /> WORK IS SUSPENDED FOR 180 DAYS..~.~] <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Electrical Contractor ' <br /> <br /> Mai~ing Address <br /> <br /> Phone <br /> <br />Cont~tor Bored Reg No. ~. ~ <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please ptqnt) <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 />Each additional 500 sq. ft. <br />or portion thereof $15.00 <br />Limited Energy $20.00 <br /> <br />Each branch circuit ~ $2.00 <br />Signal circuit(s) or a limited energy <br /> <br />FEES <br />Al. Enmrtomloffeesfrom See. g4 <br /> <br />A2. Add 5%surcharge(.05 x Al) <br /> Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Rethspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 7/97 <br /> <br /> <br />