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IF6R cr~Y VALIDATION <br /> Received By: <br /> <br /> Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Owgon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br /> Office: phone 588-5147 8:00am - 4:30pm <br /> FAX S88-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PROPERTY O~ <br /> <br /> 0 <br /> PE~S ~ NON-~S~ A~ EXP~ ~ WORK IS NOT <br /> ST~ W~ 180 DAYS OF ISSU~CE OR ~ <br /> WO~ IS SUSP~ED ~R 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, Smte, Zip <br /> <br /> Owner's Signature <br /> <br /> ;. 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 />Ser*ice Included: <br /> <br />Date: <br /> <br />Issued <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> $85.00 __ 4 <br /> <br /> $15.00 <br /> $20.00 __ 1 <br /> <br />Installation, Alteration or Relocation <br />Each branch circuit ~G $2.00 ~ <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. ~4 $ ~ <br />A2, Add 5% sumharge (.05 x Al) $ <br /> Subtotal $ <br /> <br />B. Enter 25% of line A l for Plan Review <br /> (Sec. 3), if required <br />C. Invesligation Fee (if requffed) <br />D. Reinspecfion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />