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FOR CITY VALIDATION] <br />Received By: <br /> <br /> MARION COUNTY <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 58g-$147 8:00am - 4:30pm <br /> FAX S88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />,oB I zz,S6, <br /> <br /> CROSS S~ET/ <br /> <br />PROJECT DESCRIPTION <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 />Electrical Contractor <br />Mailing Address City <br /> <br />Phone m ~ <br />FAX ~ ~ <br />Contractors License No. ~ C <br />Contractor Board Reg No. <br />Supervisor License S <br />Signature of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> Property Owner (.o~l~ <br /> <br />Mailing Address <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 />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />A. Residential Per Unit <br />Service [ncluded: <br /> <br />Numl~r of Inspections per permit allowed <br /> <br /> It~4~ Cost (¢a~h) Sum --~ <br /> <br /> $20.00 I <br /> <br />N/C <br /> <br />b)Ea~/ s2.oo <br /> <br />5. FEES <br /> Al. Enter total of fees fwm Sec. ~4 <br /> A2. Add 5% surcharge {.05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee <br /> <br />SubtooJ <br /> <br />TOTAL AMOUNT DUE <br /> <br />s / 75%35 <br /> <br />sq. fl. x $.068 =__ <br /> <br />Receipt No. <br /> <br />MC 15-34 7/97 <br /> <br /> <br />