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I;FOR CITY VALIDATION <br /> <br /> eceived By: <br /> <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr, NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> TA×^CCO NT"O. I <br /> <br /> PROPERTY OWNER ~kLx'der <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 INSTALLATIONS <br /> <br /> property Owner (please prinO <br /> Mailing Address <br /> <br /> City, 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 />PERMITNO: q~*' ~0'1~ II <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> Number of Inspections per permit allowed <br />A. Residential Per Unit <br /> Service Included: Items Cost (each) Sum <br /> <br />1000 sq. ff. or less S85.00 4 <br /> <br />Each additional 500 sq. fi. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 __ 1 <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder $40.00 __ 2 <br /> <br />B. Servlccs or Feeders (Docs not include branch circuits, see section D) <br /> <br /> 200 amps or less ~ $50.00 ~l ~OO 2 <br /> <br /> Each branch circuit ~ $2.00 ~ g~O O <br /> <br /> Each sign or outline l[ghtMg $40.00 __ 2 <br /> Signs] circuit, s) or a limited energy <br /> <br /> (As ~quired by Building Officials) <br /> <br />$.FEES <br /> A1.En~r~of~es~mS~.#4 $ ]~*O~ <br /> <br /> Subtatui $ IqO*~O <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if requffed <br />C. Investigation Fee (if required) <br />D. geinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />s iq6 *-to <br /> <br /> <br />