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FOR USE ONLY <br /> OFFICE <br />Received by:. <br />Date: <br /> <br /> ELECTRICAL PERMIT APPLICATION' <br /> Please complete all Sections, I through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 ttigh Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> PAX: 558-7948 <br /> <br />PERM1TS ARE NON-TRANSFERABLB AND NON-KEFUNDABI2~ AND <br />EXPIRE IF WORK IS NOT STARTED WITI{[N 180 DAYS OF ISSUANCE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor% License No. CO ~:/~ OQ~ ~. <br /> <br />Phone <br /> <br />2B. FOR OWNER INgI~ALLATIONS <br /> <br />Ptopeay Owner <br /> <br />Mailing Address <br /> <br />City/S/am/Zip <br /> <br />'IRe imtaIlati6n is being made on property [ own which i, not intended for*ale. <br /> <br />Owae~s Signature <br /> <br />3, PLAN 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 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 />MC15-34 11/91 <br /> <br /> SITE #: , :] <br /> Issued by: ~lAiX ON ~UtJNi Y <br /> <br />A, <br /> ~1~.II11 <br /> ~it <br /> / <br /> ~t~1~ 1~1~: It~ Cost (~a~) Sam <br /> <br /> 10~~q~, fc ~ ~s~ $~5,00 4 <br /> Each adtti~al 5~ ~q, fl, <br /> ~ ~*~of $15.00 <br /> ~ E~y $~.00 ~ 1 <br /> Each Ma~ufd Hme or M~alar <br /> Dwelling Se~ or F~d~ $40.00 ~ 2 <br /> <br />B. Ser~s or FeVers (D~s not ~1~ branch ¢ifcBa$. s~ S~C~OB D) <br /> <br /> I.stallatlon, Al.tatlonso~Reloeatlon20~ amp~ or la~ / <br /> ~1 am~ m 4~ ~px __ 2 <br /> ~1 ~ m~mps $100.00 __ 2 <br /> ~1 am~ m 1~ amps $130,00 __ 2 <br /> ~er 1~ ~ps or volts $300.~ ~ 2 <br /> ~mcct mly $40.00 <br /> <br />C. Tem~rary Se~ice~de~ <br /> <br /> 2~ ~p: or le:~ $35,00 ~ 2 <br /> 201 ~ps [o ~ am~ $40,00 <br /> 401 ~ps to ~0 ~ $80,00 <br /> ~er ~ ~ps or 1~ volts <br /> <br /> a) ~e f~ for branch ~rc~ts ~ <br /> purchase g xc~ or fc~er fee <br /> <br /> b) ~e f~ for ~ch ~mots <br /> ~rchasc of sc~icc or feeder fcc <br /> <br /> Fi~t branch clmult <br /> ~ach ~d~t[oBal b~ch c~a <br /> <br /> ~ ~mp or i~gadm clrclc $40.00 <br /> ~ sign or ~e ~gh~g ~ $40.00 <br /> Signal ~it(s) ~ a ~ted <br /> ~, ~tcration ~ cxt~si~ $40,00 <br /> <br /> ~¢r ~¢ ~owable ~ any of ~e <br /> a~v~. ~r ~s~m $3500 <br /> <br />G. Minor Ins~llation Labels <br />~¢k of I0 h~s ~ $f00 es& $~0.00 <br />eom ody to electr~al contractors) <br /> <br /> ( ~ mq~red ~ Building <br /> <br />5. FEES <br /> Al, l~nter total oI' ~%es E,om S~c. #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. En~r 2~% of llne A 1 for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (if required) <br /> D, Relnspection Fcc ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br /> <br />