Laserfiche WebLink
FOR. OFFICE USE ONLY <br />Rece[ve, d by: <br />Date: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High Strut NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 $:00 am - 4:30pm <br /> Cod:-A-Phonc: 558-7904 <br /> FAX: ~-794S SITE #: <br /> <br />ELECTRICAL PFRMIT APPLIOATION Date: <br />Please complete all Sections, 1 through 5 Issued by: <br /> <br />Permit No. <br /> <br />PEIO/ffFS ARE NON-]~ANSP~RABLE AND NON-REFLrNDABLE AND <br />EXPIRE I~ WOPoK IS NOT STARTED W1Tt/IN 180 DAYS OF ISSUANCE <br />OR IFWORK IS SUSPENDED FOR 150 DAYS, <br /> <br />2A. CONTRA~i'OR INSTALLATION ONIN <br /> <br />I;;'AF:K :1: rq EL. EC-I-Fk I C ~ I NC. <br />20250 ~,3 MOLAI,,.L,A AVENUE <br />OREGC)N CITY:, C)F: 97045 <br />24G'": 130 J, <br /> <br /> FOR OWNER INSTALLATIONS <br />Propeay Owt~r <br /> <br />Mailing Address <br /> <br />City/Slate/Zip <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 thc <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapmr 53. <br /> <br />MC 15-34 11191 <br /> <br />4. FEE SCHEDULE (Complete and eate~ total in A1 below) <br /> <br />A. Residential Per Unit <br /> <br />1000 sq, f~. or <br />Each aeld~tional 500 ~, ft_ <br />or po~cal themof $15.00 <br />Limimd Eneagy / $20,00 <br />Each Marolf ~i Home or Mc~u~r ~/,. <br />Dwelling Service or F~eder $40,00 <br /> <br />B. Serv~ce~ or Fee(lers (Doe~ aot inlcude branch ,ainu/u, sec section D) <br /> <br />$85.00 4 <br /> <br />1 <br /> <br /> R~conncct otfly $40,00 <br /> <br />a) The fee for blanch 6se~ts <br /> <br />b) The fee for branch d~euts ~idaout <br /> purchase of ~¢rvice or feeder <br /> <br /> Signal clreult(s) or a limimd energy <br /> panel, alteration or ~xtenaion $40.00 <br /> <br /> Pack of 10 labels @ $5.00 each $50.00 <br /> ( As r~quired by Building Official) <br /> <br /> 5. FEES <br /> Al. Enter tota~ of fee~ from Sec. 04 <br /> 3,2. Add 5% ,~ureha~e (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of line A1 for Plan Review <br /> (Sec, 3). ff ~qulred <br /> C, Investigation Fee (ff required) <br /> D. Re. AlSl~fion Fee ($~5,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />.... Receipt No. ,, , ,, <br /> <br /> <br />