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omo <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97_301 <br /> Phou~: ~884{147 8:00 ara - 4:30pm <br /> Codu-A-Ph~: 588-7904 <br /> ~,,~: s$$-?~s SITE #: <br /> <br />IELECTRICAL PERMITAPPLICATION I <br /> Please complete all Sections, 1 through 5 <br /> <br /> 1, LOCATION OF INSTALLATION <br /> <br />Job Addm*s <br /> <br />pERMITS ARI~ NON-T~ANSF~RABLE AND NON-REFUNDABLE ~ <br />EXI~IRE IF WORK IS NOT STARTED W1TH]~ 180 DAYS OF ISSUANCE <br />OR ~q~ WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> FOR OWNER INSTALLATIO.NS, <br />pro~ro/Owner <br /> <br />City/~ta~ip <br /> <br />The i~smlhfon is b~ing made on prope~y I own which is no~ intel for ~al~, <br /> <br />OwneFs Signature <br /> <br />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, phns, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />Date: <br /> <br />Permit No, <br /> <br />Issued by; <br /> <br />4. FEE SCHEDULE (Comp~ md em~r mt. al i~ A I I:glow) <br /> <br /> Number al' I~tlons p~ ~rmlt allowed <br /> <br />A. <br /> R~ld~flM <br /> Unit <br /> <br /> ~ ~ps ~ ~ss $~,00 <br /> <br /> oumhage~e~ ~ fc~r f~ <br /> <br /> ~ brach d~uit <br /> <br /> b) ~a tm for ~eh ~a <br /> ~fcha~e of se~ o~ feeder <br /> <br /> F~t branch ~ $35.00 <br /> <br /> ~. M~ellan~us (~lee or F~er Not Inaladed) <br /> ~ ~p ~ ~gafi~ c~e $40.00 <br /> <br /> Signal c~uit(s) ~ a ~mimd <br /> ~nel, dmmfion or ~tmsi~ $40.00 <br /> <br /> ~r ~c a~owable ~ any ~ ~c <br /> <br /> G. Minor In~llaflon ~ls <br /> <br /> (As ~qMred ~ BuiMi~ <br /> <br />s. <br /> Al. ~nt~r ~ of fees fmm <br /> A2. Add 5% sumha~ (.05 <br /> <br /> B. E~25%of~eA1 f~ ~n Revlew <br /> (S~, 3), if mq~r~ <br /> C, ~v~ga~onF~ ~ ~qui~d) <br /> D. Re~s~ca~ Fee ~.~) <br /> <br /> ~TAL ~O~ <br /> <br />, Receipt No, <br /> <br /> <br />