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FOR O ~I(.% USt. ONLY <br />gccelwa ,' <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 ttlgh Street NE <br /> Salem, Oregon 9730 l <br /> <br /> phone 588-5147 8:00 arn - d;3(¥m <br /> Cod¢-A.Pbo~¢: 588.7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL. PERMIT APPLICATION <br />Please complete all Sections, <br /> <br />1 through 5 <br /> <br />SITE #: ~'7-t¢~7 <br />Date: __ <br /> <br />Issued by: ....................... <br /> <br />2B. FOR OWNER INffI'ALLATIONS <br /> <br />PmpsrW Owmw <br /> <br />O,Jmcr's Signature __ <br /> <br />3- pi.AN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional [)lan review program docs not suspend thc <br />required submission of lighting pOwer calculations, plans, <br />and specifications when required by the Oregon .Structural <br />Specialty Cede, Chapter 53. <br /> <br />1000 sq, fl, or less <br />Each addhional 500 ,qq. <br /> <br /> $85.00 ........ 4 <br />...... $~5.00 <br /> <br />~01 amps to 4~'J amps <br /> <br />601 am~ to I{Xl0 amps <br /> <br />,5000 __. 2 <br />~60.00 2 <br />$~00,00 .... 2 <br />$1300O ___. 2 <br />$300.0O __ 2 <br />Sd0 O0 __ 2 <br /> <br />$35.00 2 <br />$40.00 -- 2 <br />$8000 --2 <br /> <br />$2.00 .... <br /> <br />S3500 .... <br /> S200 .... <br /> <br />$40.00 ...... 2 <br />$40 00 .... 2 <br /> <br />$3500 <br /> <br />$50.00 <br /> <br />5. FEES <br /> <br /> A I. Enter to~al of fees from S¢c. #4 <br /> A2. Add 5% ~urch:m_~.e (.05 x Al) <br /> <br /> Subtotal <br /> <br /> g. Enlnr 25% of llne AI fotPlan Review <br /> (See, 3), if required <br /> C, Invv..qtisation Fee (ff required) <br /> D. R¢i~';pccti~l Fee ($25,00) <br /> <br /> TO'I'A L AMOUNT DUE <br /> <br />MC 13-34 11/9] :4¢,e~ipt No, <br /> <br /> <br />