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FOR CITY VALIDATION] <br />Received By: <br /> <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <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 588-5147 8:00am - 4:30pm <br /> FAX 588-7948 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> T XACCO NO'I I I J I''l, I I <br /> <br /> CROSS STREET/ <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 ONL~i <br /> <br />2B. FOR OWNER INSTALLJ rlONS <br />Property Owner (please print) <br /> <br /> c%?z7 <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 />MC 15-34 7~7 <br /> <br />PERMIT NO: <br />Date: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />A. Residential Per U~il <br /> Service Ineluded: <br />1000 sq. ft. or]ess <br />Each additional 5go sq. ft. <br /> or portion Ihereof <br />Limited Energy <br />Each Manufactured Home or <br />Modular Dwelling Sewice or Feeder <br /> <br />B. Services cr Feeders (Does not include branch clrcalts, see section D) <br /> <br />sq. ft. x $.068 = <br /> <br />panel, alteration or exlension ~ $,40.00 <br /> <br />2 <br /> <br />5. FEES <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (if n*quired) <br /> D. Reinspeedoa Fee ($25.~) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />