Laserfiche WebLink
I FOR OFFICE USE ONLY <br />[ l~eceived by: <br />II)ate: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING 220 High Street NE <br /> <br /> Phc, n* 588-5147 8:00 am - <br /> Code-A-Phon~: 58S -7904 <br /> FAX: 588-7948 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I," FEkMrrs/~E NON-TRANSI~RABLE P2q'D NON.REFUNDABLE AND <br /> <br /> EXPIRE 1F WORK IS NOT STARTED WITFdN 180 DAYS OF ISSUANCE <br /> OR I~ WORK IS SUSPENDED FOR 1 $0 DAYS. <br /> <br />J °hS°'l0 <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTAI.,LATIONS <br /> <br />Owner <br /> <br />Mailing A~tclress Phone <br />City/State/Zip <br /> <br />The imtaUafion/~ being made on pmpeay I own which is riel intended for sale, <br /> <br />Owner's Signature , <br /> <br />3. PLAN REVIEW SEC'ti'ION <br /> <br /> We will provido plan review servke if you ~'omplete Section <br /> 5g and submit two (2) se~s 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, Chapter 53. <br /> <br />MC 15.34 11/91 <br /> <br /> Issued by: <br /> <br />4. FEE SCHEDULE (Complete ~d omar total ~ A 1 below) <br /> Number of Inspections <br /> <br />A, <br /> R~ldentlal <br /> Per <br /> So. Ice Included: It.s Co~t (och) <br /> <br />~ ~ ~mof ~ $15.00 <br /> Se0.00 <br />Each Manu~ Home or <br />~elLi~ Se~ Or F~dcr $40.00 .., 2 <br /> <br /> Inflation, Allusions ~ R~aflon <br /> ~ ~ or less ~ $ $60.00 ~ 2 <br /> ~1 ~ps ~ ~ amps ~ ~ 2 <br /> <br /> ~r 10~ ~ps or volts <br /> <br />C. Tem~rary <br /> <br /> 2~ amps or hi~s <br /> 201 ~ps to ~0 a~ps ~ $~0.00 ~ 2 <br /> 401 ~ps to ~ ~ ~ $80,00 ~ 2 <br /> ~er ~ ~ps or 10~ volts <br /> <br />D. Branch <br /> <br /> ~ba~e ~ ~ ~ fe~4e¢ fcc <br /> <br /> b) ~ fm for ~h ~mts ~out <br /> <br />~, Ml~ellan~us (~rvice or F~er Not Incloded) Each ~p or i~m ~ml~ <br /> Ea~ si8~ or ~ffi~ ~h~8 ~ $40.00 2 <br /> <br /> ~ncl. ahcmtion ~ ~t~si~ ~ $40.00 ~ 2 <br /> <br /> ~er ~ ~owab[~ ~ any of <br /> a~e, ~ ~cE~ <br /> <br />G. M}nor lnsmllathin La~els <br />Pack ~ 10 la~s ~ ~,00 ca~~ $~0,00 <br />(soM o~y to ~lec~i~ co~tor~) <br /> <br />5. FEES <br />Al. Bmer t~al of fe~ f~om Sec, #4 $ J ~J0 .CC..} <br />A2, Add 5% sumha~ge (,05 x A 1 ) $ ~ <br /> <br /> Sub~tal $ <br /> <br /> B, Enter ~% of ~ Al for Plan R~i~w <br /> (S~. ~), if ~r~ $ <br /> C, ~v~dgati~ Fcc (ff~q~md) $ <br /> D, Re~sp~d~ Fee ~25,~) $ <br /> <br /> '~TAL kMO~ DUE <br /> <br />R~ccipt No, <br /> <br /> <br />