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FOR oFFicE~.?US~ ONLY <br />Date: ~/~-~>/c7 ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Stxeet NE <br /> Salcm, O[e. gert97301 ._. ::: <br /> <br /> Code-A-Ph"m~: 588-7904 <br /> FA~.r ~-7948 <br />ELECTRICAL PERMIT AppLIcATIONI <br />P/ease complete all Sections, I through 5 <br /> <br />LOCATION OF INSTALLATION <br /> <br />D,~¢ription <br /> <br />PERM,'TS ARE NON-TRANSFERAnLE AND NON-REFLINDAFI LE AND <br />EXPIRE IF WORX IS NOT STARTED WITIflN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSpENDBD FOR 180 DAYS. <br /> <br />2~,. ¢o~rrRACTOR INSTALLATION ONLY <br /> <br /> I'~ ~ ,~ ~. <br />Ma~g Add.ss <br /> <br />Prop~ty Owner <br /> <br />PropcrB, Owner <br /> <br />The installation is }~eing made on p re, IX:ny [ own which is not intended for sale. <br />3, PLAN REVIdSECTION - T ~/ <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 />'rhis optional plan review program does not suspend the <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 15-34 11/91 <br /> <br />Permit No, <br /> <br /> FEES <br /> <br />A 1, Enter total of fees from Sec. #4 · <br />A2, Add 5% s~rcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B, Enter 25% of line Al for Plan Rev{aw <br /> (Sec, 3). if t~qtlir~ <br />C. InvestigatlonF¢¢ (ff ~qoimd) <br /> <br /> TOTAI~OU~r DUE <br /> <br /> SITE #: <br /> <br /> .... tJaie: __ <br /> <br />[,~AR[ON OOt~ttt~d by <br /> <br /> 4, ~E SCHEDULE (C~pleto ~d enter ~oml ~ A l b~ow) <br /> <br /> A. <br /> R~identlal <br /> Per <br /> Unit <br /> <br /> lO~ sq, A. or <br /> Each ad~6~l 5~ a;q, ft. <br /> ~ ~ffim ~cmof $15.00 <br /> L~imd Enee~y $~0,00 <br /> Aa~ M~uCd ~me or M~ular <br /> Dw~ng <br /> <br /> [n~llatlon, Al~ratlons ot Rel~atlon <br /> ,so,oo <br /> <br /> ~1~ <br /> $300,~ <br /> ~mmect rely $40~00 <br /> <br /> C. ~r~y Servlee~d~ <br /> <br /> ~ raps or less $35,ec <br /> 201 ~p~ to ~0 am~ $40,00 <br /> 401~ gto~am s <br /> <br /> D. Branch Clreul~ <br /> a) ~e f~ for brach clmultq <br /> Each brach c/muir $2.~ <br /> <br /> ~a~ addliionM br~ c/mint $2,00 <br /> <br /> E. Mi<ellant~us (Serv~ or ~eder Not Included) <br /> 40,00 <br /> ~h ~mp or i~igafim c~ $ $40.00 <br /> Signal c/muir(a) or a l/m/md ene~.y <br /> <br /> Pack of 10 la~ls ~ $5 ~ ea~ $50,00 <br /> (As mqulred by BtliMing Officio <br /> <br /> <br />