Laserfiche WebLink
FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 3734427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> ,AXA O NO. I{,al. t I 31: t4 I- I0101o <br /> <br /> I I 'l-I'l I <br /> CROSS S~ET/ <br /> DI~CTIONS <br /> <br /> N-T~SFE~LE A~ E~ 1F WO~ IS NOT I <br /> I <br /> ST~D ~TH~ 180 DAYS OF ISSU~CE OR IF <br /> WO~ IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />ContractorBoardRegSo. ¢~ 3 3 <br />s,,p~iso,,.ice.~ ~h.% 3s <br />Signature of Supv. Elecll'icia~:,/~&~ ~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> Cig/, State, Zip <br /> <br /> Owner's Signature <br /> <br /> L 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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete aud enter total in Al below) <br /> <br />A. Residential P~c Unit <br /> Service Included: <br />1000 sq. ff. or less <br />Each additional 500 sq. i~ <br /> or potion thereof <br />Limited Energy <br />Each Manufactured Hom~ or <br /> <br /> $85.00 <br /> <br /> $15.00 <br /> $20.00 1 <br /> <br /> $40.00 2 <br />200 amps or less / S50.00 ~2 <br /> <br />FEES <br />Al. Enter total of fees from S~¢,//4 <br />A2. Add 5% surcharge (.05 xA1) <br /> <br />B. Enter 25% of line Al for Plan R~view <br /> (Sec. 3), if ~qulred <br />C. Investigation Fm (if required) <br />D. Reinspectlon Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br /> <br />