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FOR OFFICE USE ONLY <br /> Received by: <br />I Date: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING <br /> 220 High Street NE <br /> Salem, ~gon 97301 <br /> <br /> ~e-A.~one: ~88-7~4 <br /> <br />I,EILMIT3 ARE NON-qI~ANSFERABLE AND NON-REFUNDAI~ LI~ AND <br />EXPiRE IF WORK IS NOT STARTED WrI'I4IN 1 gO DAYS OF LgSU ANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Prop~rt70wr~r <br /> <br />Mailing Address Phone <br /> <br />City/St atdZip <br /> <br />Ow~ner's Signature ...... <br /> <br /> PLAN REVIEW SECTION <br /> <br />We will provid~ plan review service if you complete Section <br />51t and submit two (2) sets of p 'lens 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 />MC 25-34 11/91 <br /> <br />~. FEESCHEDULE (Complete ;md roller lotal in A1 below) <br /> <br />1000 sq. f~ or less $85,00 <br /> <br /> or ~ ~e~of $15.00 <br />~i~ ~c~ $20,00 <br /> <br /> ~am~ ~ leas /_~ ~50,00 <br /> <br /> ~1 am~ to 6~ ~pa gl00.00 <br /> ~I ~m~ ~ l~0 amps <br /> ~r 1~ ~p~ or volts $~0,~ <br /> <br />Temporary Servlces/Fee~ters <br />luatallatlon, AU~caflon, or Relocation <br /> <br />a) The f~e for branch c~is ~ <br /> u.p_~ch ~ S~ at' ~e~¢~ or f~r f~ <br /> Each br~ circuit ~ <br /> <br /> Each ~mp ~ ~igafim c~e .. <br /> SiOm[ ¢~uil(s ) m a lla~md cne~y <br /> <br /> (As ~qulred by BuiMing Officio <br /> <br />$35.00 <br />$40.00 <br />$80.00 <br /> <br />$2.oo 5/~') ~ <br /> <br />$35.00 ~,, <br />$2.O0 <br /> <br />$40,00 <br />$40,00 --2 <br /> <br />$40.00 .... 2 <br /> <br />$35.00 .... <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al, Enter total of fees from Sec, #4 <br /> A2. Add ~% surcharge (,05 xA1) <br /> <br /> Sabtotal <br /> <br /> . (S<. 3),ifmqulrcd <br /> C, ~vcstlgaQ~Pcc (ff required) <br /> D, Rdns~cli~ Fee ($2~,00) <br /> <br /> ~'I~L AMOU~ DUE <br /> ~i¢ Nq., _, ,, : <br /> <br />$ <br /> <br /> <br />