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FOR OE~}IC,D USE ONLY <br />Received by~ <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Street NE <br />Salem, Oregon 97301 <br /> <br />Phon~ 5{18-5147 8:00 ~un - 4:30pm <br />(,k~d~ -A -F'non~: 5118-7904 <br />FAX'.~j88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete afl Sections, I through 5 <br /> <br /> I, LOCATION OFINSTALLATION <br /> <br />$obadd~. 336> 5fl~Vt~ <br />City t7~7~ z~ / ~ } Cross <br /> <br /> P~ ~E NON.~NS ~RA~LE ~D NON-~E~NDAB LE <br /> E~E ~ WORK IS NOT STARTED Wl'~1~ 1 gO DAYS OF ISSUANCE <br /> OR ~ WO~ I$ SUSP~DED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Ele~r/ealConlraetor .~oy..&l ly/&,¢y '$ I~.~:~-~-. }Phone <br /> <br />.Contractor's Lieemse No. /.~1~_~.~- 52L q,' I ~ ,C~ <br />Contractor's lloa~ Reg, No. Z~- t~- ~ Lp ~t. [ Job NO, <br /> <br />Supervi~or'sUcenseNo, / ~J~ ff [ }PhoneNoTgq_Z/2_qr. <br /> <br />2B. FOR OWNER INSq'ALLATIONS <br /> <br />Mailing Address / Phone <br />Cily/State/Jl p <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plm~ review service if you complete Section <br />513 and submit two (2) sets of plans and specifiofions wiI.h <br />this application. <br /> <br />This optional plan rewew program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specificat/ons when required by the Oregon Structural <br />Specialty Code, Chapter 53, <br /> <br />Issued by: ,t,~, e,n~t~4'f¥ <br /> <br />?00 sq. fl. or less $85.00 <br />llach,- ad~d~al 5~ s9, E. <br />~ ~ theme/ ~ $15 ,OO <br />L~ Enemy $20.00 <br /> <br /> Dwe~g S¢~m or Feeder ...... $40.00 <br /> ~ ~m¢ ~ less $50.~ <br /> <br /> 2~ raps or less <br /> 201 ~ps to <br /> <br /> ~¢~ ~?s ce 1 ~ volts <br /> <br />D. Branch ClrcuIB <br /> <br /> a) ~e f~ for branch ~5rcuiu <br /> <br /> ~mba~* 9f ~e~iee or (~ed~ fee <br /> <br /> Pi~l branch circuit <br /> Each addifi~M branch circui{ <br /> <br /> Signal circuil(~) <br /> <br /> at~v¢, ~r In~cfion . $35 00 <br /> Pack of 10 la~ls ~ S5,~ ea~ .... $50 O0 <br /> <br /> FEES <br />A 1, Bntcr total of fees from Sec, #4 <br />A2. Add $% surcharge (,0S x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of llne A 1 for Plan Review <br /> (Sec, 3). if ~quired <br />C. ][nve~tigationFee (il' reqt~if¢d) <br />D, Rclnspe~dc~ Fee <br /> <br /> TOTAL AMOUN-r DUE <br /> <br />$ <br /> <br />MC 15-34 11191 Receipt No. <br /> <br /> <br />