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FOR OFFICE USE ONLY <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> <br /> 220 High S ,m~.t NE <br /> Salefi~, Oregon 97301 <br /> <br />Phone 58S-5147 S:00 ~n - 4:30pm <br />Code-A-Phm*: 588-7~ <br /> P~: 588-7~8 <br /> <br />IELECTRicAL PERMIT A.PPLICATION <br />P/ease complete al~ Sections, 1 thro~ugh 5 <br /> <br />I, LOCATION OF INSTALLATION <br /> <br /> I <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-R~I~JNDAB LE AND <br />F~CP~CRE IP WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR 117 WORK IS SUSPENDF, D FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br />Electrical C~tractor <br /> <br />Phone <br /> <br />Mailing Address <br />Pmpcny Owner ]"Phone <br /> <br />Job No, <br /> <br />Comraelor's Board Res, No, <br /> <br />Signature cS SuFc~islng Electrician <br /> <br />License No, <br /> <br />2B. FOR OWNER INSWALLKFIONS <br /> <br />PPe~l~xty Owner <br />m~A~. ~ 7/7/Y~/~ve <br /> <br />Omc?* S~mmm .... ~ ~ . [[ ............ <br /> <br />3. PLAN REVIEW SE~ION <br /> <br /> We will provide pl~ rehew seffme if you comple~ S~fion <br /> 5B and mbmit two (2) sets of plus ~d s~Wtmfions wi~ <br /> this application. <br /> <br />This optional plan review program does not suspend [he <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 1§.$4 11/91 <br /> <br /> Date: <br /> MARION COUNTY <br /> Issued %~i_iiLDiN6 ih3FEOTiO;4 <br /> <br />4, ~E SCHED~E (~ete md ~r m~ in A 1 ~ow) <br /> <br />A. <br /> R~lflentl~ <br /> Unit <br /> <br />ggh ad~fi~l 5~ sq. <br /> <br />~md Enemy $~,00 <br />Ea~ M~Pd ~me or <br />Dw~ S¢~m m Feeder $40.00 <br /> <br /> Inflation, Al~atlons or Ra~aao~ <br /> <br /> ~1 ~ ~o ~ ~p~ $~00.~ <br /> ~er I~ ~ps or volu $~0.~ <br /> <br />C. Temporary Service~Feed~-s <br /> Installation~ Alteration~ or Relocation <br /> 200 ~ps or less <br /> 201 ~ps to ~ am~ <br /> ~r~ ~ps or 1~ rOIlS <br /> <br />D. Brauch CtrcuiLs <br /> <br /> a) ~ f~ for ~ch dm~ <br /> pumha~e ~ ge~i~.,~ f~cr f~ <br /> <br /> F~t ~nch cimuit <br /> ~ addifion~ bm~ clmuit <br /> <br />~. Mi~ellan~us (~rvice or Feeder Noi lnclu~8) <br /> ~ach si~ or once ~h~g <br /> <br />~. ~ch aO~laonal Insp~ti~ <br /> ~er ~e ~able ~ any of ~ <br /> <br /> ~ek ~ 10 la~ls ~ $5.~ <br /> (~old ody to *l~ctricM co~mctor*) <br /> <br /> ( As mq~red by Building Offic~l) <br /> <br />5, FEES <br /> Al. Enmr mai of fees fm Se~ ~4 <br /> A2. Add 5% sur~a~e (.05 x Al) <br /> <br /> Subto~ <br /> <br /> B. Enter ~% of ~e A 1 for Plm Review <br /> (Sm. 3), ff gq~ <br /> C. ~vesfigafi~Fe¢ <br /> D, R~s~fi~ Fee ($~,~) <br /> <br /> ~IDTAL AMO~ <br /> <br />$35.0O 2 <br />$40,00 __ 2 <br />$80,00 __ 2 <br /> <br />$2.00 <br /> <br />$35,00 <br /> $2.oo <br /> <br />40,00 <br />40,00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$5o.oo <br /> <br />Receipt NO., ...... <br /> <br /> <br />