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Received By: Da~e: <br />Zoaing By: CRy: <br />Receip~ #: Amount: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> parcel ID: <br /> <br />IP~P,~I'I'S ~ NON-TRANSFERA~L~ AND F-.XPIPJ~ iF WORK <br /> ~$ NO~ STARTED WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK ~ SUSP~¢DED FOR ISd DAYS. <br /> <br />an. com'~,, c'rog n~FOOf~T~ON <br /> <br />blailiug Address: <br /> <br />Coeh-acto~ Board No.: <br /> <br />Stere: Zip: <br /> <br />C. kmU-zcwr Lic~me No.: <br /> <br />Supervisor Licens~ No.: <br /> <br />Siguatux~ of Supervising ElecU'i. cian: <br /> <br />st~tum is soM or offe~ for ~ ~o~ or u~n ~t~ lf l <br />~ ~t~n Co~o~ B~ If I c~nge my miM ~ do <br />C~t~cto~ B~ I will i~d~tely ~t~ MaHon Coun~ of t~ <br /> <br />MC 15-34 R~v 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (compl. and enter total iix Al) 9q ' ~$~0 <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of llne Al for Plan Review <br />C, Investigation Fee (if requirext) <br />D, Reinspection Fee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br />E Inspection for w~ch rio fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Indus~al Plant ($62,50~u-) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br /> <br />$__ <br /> <br /> <br />