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IFOR OFFICE USE ONLY <br />Re.c~ived by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, i through 5 <br /> <br />MARION COUNTY BUILDING INSPECTI.0.N <br /> <br /> Pe~it No. <br /> F~: 58S-7~8 SITE <br /> <br /> mssued by: <br /> <br />L LOCATION OF INSYALLATION <br /> <br />D~cdpm~ <br /> <br />P~P..MITS ARE NON.TRANSFER~BLI[ AND BION~REFUNDABLE AND <br />I~XPIR~ Il~ WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR 1~ WORK IS SUSPI~NDI[D FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> ,.~ <br />MailJn$ Address ~ <br /> <br />Si~natun~ of Sul~zvlsias gle~tfidan ~ <br /> <br />FOR OWNER INBTALLATIONS <br /> <br />Mailing Address Phone <br />Cityf& ate4Zip <br /> <br />Th8 i~stgH~tion is b~ills made on ~ I own which is nc~ in[mu]ed for sal~, <br /> <br />Owner's Signamr~ <br /> <br /> iiim <br /> <br />3. PLAN REVIEW SECTION <br /> <br />4. FEE SCHEDULE (Cor/l~et¢ and mt~r total in A I b~low) <br /> <br /> Number ~ IRspe~tlons per pemlt allowed <br /> <br />A. <br /> R~enflM <br /> ~r <br /> U~t <br /> / <br /> Se~l~ Include: It.s C~t (~h) <br /> l~s~ ~ ~ss ~ $~.00 4 <br /> ~ ~ ~m~ $15.00 <br /> ~ ~e~y $~,00 ~ 1 <br /> ~ ~d Home or <br /> <br />B. Ser~ or Fe~em ~s am ~ b~ch ~rc~ts, s~ scc~ D) <br /> <br /> ~ ~ ~ les~ $50.00 ~'0~ <br /> ~1 ~:~ ~ ~ ~ps $~.00 __ 2 <br /> <br /> ~er 1(~ ~ps or vo~ $300.~ -- 2 <br /> [~em ~y $40.00 __ 2 <br /> <br /> C. T~ary <br /> <br /> 2~ ~ps or less $35,00 ~ 2 <br /> 40.00 <br /> <br /> D. Branch Cl~ui~ <br /> New, AIt~ation~ or ~slou Per <br /> <br /> ,~$p of ~ewlce or f~der fee <br /> ~t b~ ~C $~5,00 <br /> <br /> ~, Mi~elian~us ~ervIce or~e~ Not Indaded) <br /> ~h ~mp ~ i~gafi~ dmlc $40.00 ~ <br /> <br /> ~ si~ or ~a ~h~g ~ $40.00 , . <br /> <br /> ~nel, ~m~o~ ~ ~s~ $~.00 ~ 2 <br /> <br /> ~, ~ ~fi~ $35.00 <br /> G. Minor Ins~llatlon <br /> <br />H. <br /> (As ~q~red by B~dd~ <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and spec~cations with <br />this application. <br /> <br /> Thi~ optional plan review program do~s not suspend the <br /> required submission of lighting power calculations, phns, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />5. FEES <br /> Al, F. ntcr total of fees frmn Sec. #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> B, Enter25% of lineAl forPlan Review <br /> (S~, 3). ff X~luited $ <br /> C. Investigation Fe~ (if <br /> D. Reinsp~nica Fe~ ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ ,f, · o o <br />$ <br /> <br />...... R~iptN0- - <br /> <br /> <br />