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IFOR OFFICE USE ONLY <br />Received by: <br /> Date: ' <br /> <br />MARION COUNT'~ BUILDING INSPECTION <br /> "220 Yligh Street NE <br /> Salem, Oregon 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION ' <br />Please complete all Sections, 1 through 5 <br /> <br />PE2,MITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXFJRE IF WORK IS NOT ~;ITARTED WITHhN 180 DAYS OF iSSUANCE <br />OR rP WORK fS SUSPENDI~D FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br /> ,,, " ' ? <br /> <br />Signatu~ of Supervising Ele~trleian <br /> <br />~B. POR OWNER INST~/LATIONS <br /> <br />P~ Owner <br /> <br />Mailing Address Phone <br />Gty/StatefZ[p <br /> <br />The installation it: I:~ing made on pmlmrty i own which is not intended for sale, <br /> <br />Owners Signatur~ <br /> <br />3. pLAN REVIEW SE~rlON <br /> <br />We will provide plan review service if you complete Sex:don <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />Phone 588-g147 8:00 ara - 4:30pm <br />Code-A-Phone: 555-7~04 <br /> FAX: 588-7948 <br /> I <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power caJculation& plan~, <br />and specifications wher~ required by tho Oregon Structm'~l <br />Specialty Code, Chaplet 53. <br /> <br /> Parmt N~C·./ <br /> SITE#: tt*~.. ~ , ~.~ <br /> <br /> Date: · ..... <br /> .~mu~ ~OUN'I y <br /> Issued ~IDI~ ~to~ <br /> <br />B~ ~nrd Home or <br /> Dw¢~ng Se~m m Fecd~ $40.00 <br /> <br /> ~ am~ ~ less $50.00 .,. 2 <br /> <br /> 2~ ~ps or less $35,00 2 <br /> 201 raps m ~ am~ $40.00 . 2 <br /> ~1 ~ps to ~0 am~ $80.00 <br /> <br /> a) ~ f~ for b~ch dm~ts ~ <br /> <br /> Each btmch ~uit $2.~ <br /> <br /> Fiml branch circuit <br /> ~ch addi~m~ branch ~uit ~ $2.00 <br /> <br />E- Mh~llan~us (~rvi~ or Feed*~ Not Included) <br /> <br /> a~, ~r h~cfi~ $35.00 <br /> Pack ~ 10 la~ ~ ~,00 ea~ $50,00 <br /> <br /> (As mq~d'by ButMi~g <br /> <br /> FEES <br />AI, Enter total of fees from See. ~4 <br />A2, Adtl 5% smchatg~ (,05 x Al) <br /> <br /> Subtotal <br /> <br />B, Ente~' 25% of llnc A 1 for Plan Revlew <br /> (S~. 3),if <br />C. ~v~figa~on Fee Of ~qu~d) <br />D, R~cfim Fee ~.00) <br /> <br /> TOTAL AMO~ DUE <br /> <br />MC 15.34 ]1/91 P,~oeipt No. <br /> <br /> <br />