Laserfiche WebLink
FOR OFFICE USE ONLY <br />Received b~y'.o <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTEK <br />285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 S:00 ~ - 4:30pm <br /> Ood~-A-Phone: 533-79~4 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, 1 through 5 <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />Descripdon / '~' 4 /J~ ~ <br /> <br />PE1UVllTS ARE NON -TRANSFERABLE AND NON -RBPUNDABLB AND <br />EXPtRE IF WORK Is NOT STARTBD W1TI I~q tS0 DAYS OF %SSUANCB <br />OS- IF WORK lS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONei'RA(-'FOR INSTALLATION ONLY <br /> <br />2IL FOR OWNER INS*rALLATIONS <br /> <br />Property Owncr <br />Mailhrg Addross Phone <br />City/State/Zip <br /> <br />3, Iq. AN REVIEW SECTION <br /> <br />Wc will provide pltm review service if you complete Section <br />5B and sabmit 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, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Ctlapter 53. <br /> <br />SITE #: Permi~ No, <br /> <br />FAX: 588-7948 <br /> <br />Issued by: <br /> <br />4. FEE 8CHEDULI~ (Complete and enter total i~ A1 b~low) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> / <br /> Service Included: Iterna Co~t (each) Sum/ <br /> <br /> 1000 sq, ft, or less $85.00 -- 4 <br /> Each additional $00 sq, <br /> or pordon thereof .. $15.00 <br /> Limimd E~e~gX ~ $20.00 1 <br /> Dwelling 8ewlc~ or Feeder / $40.00 ~ 2 <br /> <br />Each hra~ch circuit <br /> <br />Signal circuit0) or a limited energy <br /> <br />$35,00 <br />$40,00 <br />$80,00 <br /> <br />$35.00 <br />$2.00 ..... <br /> <br />$40.00 . 2 <br />$40.00 2 <br /> <br />$40,00 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> Al, Enter total of fees from Soc. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Submtal <br /> <br /> Et. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if reqair~l <br /> C. Inve~tlga{ionFee (ff required) <br /> D. Reinspecfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Mt? 15-34 8/94 Receipt No. . <br /> <br /> <br />