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BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br />Received By: Salem, Oregon 97305-1398 Date: <br />Date: 24 HR Inspection Line 373-4427 <br /> <br /> Office: phone 588-5147 8:00am. 4:30pm ! Issued by: <br /> FAX 588-7948 · · <br /> <br />ELECTRICAL PERMIT APPLICATION 4. FEE-S~I~DULE (Comple~te and enter total in Al below) <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />I*^xAcCo~o- I'~ l~ ~/I~/1~-I ~1/lO <br /> <br />~o~hG 0m ' , <br /> ,-,,,, <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED 'vVITH1N 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br />Mailing Address City <br /> <br />FAX --- --. <br />Contractor Board Reg No. <br />Supervisor License S <br />Signature of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br />A. Residential Per Unit <br /> Service Included: <br />1000 sq. ft. or less <br />Each additional 500 sq. ft. <br /> or portion thereof <br />Limited Energy <br />Each Manufactured Horfie or <br />~Modu]ar Dwelling Service or Feeder <br /> <br />$85.00 4 <br /> <br />$15.00 <br />$20.00 ~ <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 />5. FEES <br /> <br /> (Sec, 3), if requhed $ <br /> <br />Receipt No, <br /> <br />MC 15-34 7/97 . <br /> <br /> <br />