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IFOR OFFICE USE ONLY <br />Received by: .... <br /> Date: <br /> <br />'" ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INS~I'ALLATION <br />l~Add~, 8864 Shaw Square <br />cay A~msville I C~sSc <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 1220 High Sueet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 5~-5 t47 <br /> Cod¢-A-~o~¢: 588.7904 <br /> F~: <br /> <br /> Date: <br /> <br />Rd. SE <br /> <br />P/~RMIT~ AR[/NON.TRANSFERABLE AND NON.RI/FUNDAB LI/AND <br />F2/PIR~ ~ WORK IS NOT crARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IP WOKK IS SUSPEND{RD FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />~C~r Code Electric {Phoa~ 581-8684 <br />MaLUngAd4mss 2717 22nd St. SE - Salem <br /> <br />Contracto?s Lic~s~: No. 24-75C <br />~ontr~ctor's Bo~ Reg. No, 1 9 8 6 6 I Yob No. <br /> <br />?B, FOR O~rNER INSTALLATIONS <br /> <br /> . j <br />MMimg Address Phone. <br /> <br />~ ins[elAtion ;~ b~ing made on property I own which is n~ ingndcd for s~, <br /> <br />Owne. t's Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br /> We will p~vide plan review service il' you complete Settles <br /> 5B and submit two (2) sets of plans and specifications with <br /> this application. <br /> <br /> This optional plan review program doe~ not suspend the <br /> required submission of lighting ix}wet calculations, plans, <br /> and spe~:ifigation$ when required by tho Oregon Smictural <br /> Specialty Ca:lo, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Permit No. <br /> <br /> Issued by: <br /> <br />4, FEE SCHEDULE (Complete and cn~r total in A l below) <br /> <br />A. Residential Per Dnit <br />Service [nctudefl: [t~s Cc,~t (~ach) gum <br /> <br />1000 sa, fa or l~ss . $85.00 <br />E~h additional 500 ~q. fi, <br />LimiU~d En~,gy $20.00 -- 1 <br />Each Manufd Home or MOdular <br />DwclUng Sacviat~ Ot Fgedgr $40.00 <br /> <br />B. Servloe~ or Feecers (Do~s not udcude b~nch omulta, sr~ section D) <br /> <br /> 50 00 <br /> 2IX) amps or I¢s$ · <br /> 201 aro~ m 400 amps <br /> 401 romps to 6(10 a,npt{ $100.00 ...... <br /> ~)1 amps to I000 amps $13000 .., <br /> Over lO00 a~ps or volts $300.00 <br /> P, ecoramct ooly <br /> <br />C, Fe nporary Scrvices/Feedegs <br /> <br /> 200 amps or less $85,00 <br /> 201 amps lo 400 amim $40,00 : <br /> 401 ~nps to ~ ump~ _~ ga0,00 <br /> ~ar~ ~ps of 1~ volts <br /> s~ "B" a~v~ <br /> <br />D, Branch Circuits <br /> <br /> a)~ f~ for branch <br /> purchase, of <br /> <br /> ~ch brach clrcuk <br /> <br /> b) ~e f~ for branch ~rcuta wi~out <br /> <br /> ~ve. ~r ~cfion $35,00 <br /> <br />5. FEES <br /> Al. ~t~r tmal of f¢¢~ f~m Sec. ~4 <br /> A~, Add 5~ sumha~e (,05 x Al) $ <br /> Su~ $ 40.95 <br /> <br /> (5~, 3). it ~r~ <br /> <br /> Recci~ No, <br /> <br /> <br />