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IFOR OFFICE USE ONLY <br />Received by: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High SUeet NE <br /> Salem, Oregon 9730! <br /> <br />Phone ~88~147 8,x00 am - 4:~ <br />~e-A-~: ~88-7~ <br /> F~: 588-7~8 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete afl Sections, I through 5 <br /> <br />L LO~ATION OFINSTALLATION <br />Job Address <br /> <br />PERMITS ARB NON.TRANSFERABLE AND NON.RBFUNDABLE AND [ <br />~B IF WORK IS NOT STARTED W1TI-11N 150 DAYS OF ISSUANCB <br />OR IP WORK IS SUSPI~NDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> FOR O~qER INSTALLATIONS <br />Pro~zty Owner <br /> <br />Ma/ling Address Phone <br /> <br />Chy/StatcffJp <br /> <br />Thc instailatiorl is I~ing mad~ ca poYt3eny I own wM, eh is n~X invaded for sale, <br /> <br />Owners Signature ..... <br /> <br />3. PLAN REVIEW SIn"TI'ION <br /> <br /> We will provide plan review semce if you complete Section <br /> 5B and submit two (2) sets of plans and specLqcations 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 Structmal <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br /> DEC 0 0 1993 <br /> Issued by: <br /> <br />A. <br /> R~ldeaflM <br /> ~r <br /> Unit <br /> I <br /> $e~l~ include: h~s Cost (e~h) S~l <br /> 1 ~ sq, ~ ~ ~ss ~ $85.00 4 <br /> <br /> B. Ser~orFe~er,~sno~eude~ee ,~ ~/ <br /> Ins~laflon, Alt~ations ~ Rd~n I ~ <br /> ~ amps ~ less ~-- 2 <br /> ~1 am~ to 4~ ~ps ~ $~,00 <br /> <br /> R~cc ~y ~ $~,00 2 <br /> <br /> 2~ amps or~s~ $35,00 ~ 2 <br /> 401 ~ to ~ ~ $80.00 2 <br /> <br /> b. B~nch CJ~u[~ <br /> New~ Al~atlon, or ~$1on Per ~nel <br /> <br /> b) ~ f~ f~ b~ d~ts ~Out <br /> ~S~ of ~c~ or feed~ f~ <br /> <br /> ~ si~ or mffi~ ~h~g $40.00 ~ ~ <br /> Sign~ cimait(s) or a H~md ~gy <br /> <br /> a~, ~ ~ofi~ $35.00 <br /> <br /> (~oM oMy to electrical co~ctor~) <br /> <br /> ( A,* mq~red ~ gulMing OfficaO <br /> <br /> Al, ~mt t~ of fccs f~ S~ ~4 $ ~ <br /> A2. Add 5% sureha~e (.05 xAl) $ <br /> <br /> Subt~ $ <br /> (~. 3), if ~q~t~ $ <br /> <br /> ~TAL AMOU~ DUB <br /> <br />Receipt No, , <br /> <br /> <br />