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iOR omc UsE bnLY <br /> eceived by: <br /> ate: _ _ <br /> <br />ELECTRICAL PERMIT APPLiCATiON ~ <br /> <br />Please complete all Sections, i through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 58S-5147 8:00 a"a - 4:30pm <br /> C.~le-A-l~hon¢: 55g-7904 <br /> FAX: 588-7948 <br /> <br />pERIVII'I~ ARE NON -TR~NSI~gPxABLE P~D I~ON-R~FIfNDABI~ ANT~ <br />~E ~ WORK IS NOT ST~T~ ~ la0 DAYS OF mSU~CE <br />OR/F WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />pr~ Owner -- .- , Phone ~ , .~ ,,~ <br /> <br /> FOR OWNER INSTALLATIONS <br /> <br />Prop~Ry Owner <br /> <br />City/State,Zip <br /> <br />The [nStatlatton is b~jag made on prol~rty [ own whichis ~o~ intended for sal~, <br /> <br />Owner's $Jgrmtum ~ <br /> <br />3. PI,AN REVIEW SECTION <br /> <br /> We will provide plan review service if yon complete Section <br /> ' 5B and submit two (2) sets of plans and specitlcations with <br /> this application. <br /> <br /> This optional plan review pmgr,'tm does not suspend the <br /> required submission of lighting pOwer calculations, plans, <br /> and specifications when required by thc Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-$4 11191 <br /> <br />SITE #: <br />Date: <br />issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total hl Al below) <br /> <br /> Number of Inspections p~ permit <br /> <br />A. <br /> Reslden~al <br /> ~r <br /> Unlt <br /> <br /> $85.00 <br /> <br /> ~ amps or less $50,00 <br /> ~1 am~ to ~ ~ps ..... $1~,~ <br /> <br /> 2~ ~ps of less $35,00 <br /> <br /> a) ~e f~ for brach ~tC~tS ~ <br /> ~ase of ~m ~ fe~ee fee <br /> <br /> ~ch ~mp or ~gafim 6rcle ~., $40,00 <br /> Each S~ or ou~c l~gh~g ~ $40,~ <br /> Si~ ctrc~t(~) or a ~[ed enemy <br /> <br /> ( Ay ~q~red ~ Building Offk~l) <br /> <br />~. FEES <br /> <br /> A~. Add 5% surcha~e (.0~ x A 1 ) <br /> <br /> C, Invesfiga~on Fee (ff mqulfed) $ <br /> TOTAL AMOU~ DUE $ ~ <br /> Receipt No, ~ . <br /> <br /> <br />