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Received by: <br />Date:.,, i I <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPI~-~ <br /> <br /> Salom, ~g~ 97301 <br /> <br /> F~: 588-7~8 <br /> <br /> 4, ~g SO'EDgE (Complete md cn~r ~1 ~ A 1 ~ow) <br /> <br />pBI~VII'T8 ARB NON -TRAN$1:~I:tABLB AND NON-P~FLINDABLIi AND <br />BXP/RE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF W ORlC.. IS SUSP.~ql)ED FOR 1 S0 DAYS, <br /> <br />{Phone ~. <br /> <br />2A. CONTI~tACTOR INSTALLATION ONLY <br /> <br />,:,., Prope~y Owner [ Phon~ <br /> <br />Signama: of SUl~rvising Ele~trieAan <br /> <br />Prof.,CO' Ow'hca' <br />Mailing Address Phone <br />City/gt at~/-Lip <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review se~ice if you complete Sect{on <br />5B and submit two (2) set~ of plans and specifications with <br />this application. <br /> <br /> This optional phn 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, Chaptex 53, <br /> <br />MC 15.34 11/91 <br /> <br />SITE #: <br /> N1ARION COUNTY <br />Oate: ~UiLIJJNG iNSPF. CTiON <br /> <br />Issued by: <br /> <br />$85,00 ~ 4 <br /> <br />$15.00 ~ <br />$~0,00 ~ 1 <br /> <br />A. Residential Per Unit <br /> Service Included: <br /> <br />1000 sq,/~ or l~ss <br />Each additional 500 sq, fl, <br /> or portion thereof <br />Limited Enm, gy <br /> <br /> $40.00 <br />Servl~ez or FeederS (Does not/nlcude branch mrcu~. ~e~ section D) <br /> <br />50.00 <br />60.00 <br />$100.00 <br />$130.00 <br />$~00,00 <br />$40,00 <br /> <br />$35.00 ~2 <br />~40,00 ~2 <br />80,00 2 <br /> <br />$2,0O <br /> <br />$35.00 <br /> Sa,Od <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40,00 ~2 <br /> <br />Sso.oo <br /> <br /> Over 1000 amps or volta __ <br /> Reconnect only <br /> <br />C, Temporary <br /> <br /> 201 ~ps [o ~ <br /> ~1 ~ps to ~0 ~p~ <br /> <br />D. Branch Ci~l~ <br /> <br /> b) ~ fm f~ ~h <br /> ~mhase of se~,pr fezder f~ <br /> <br /> Fint ~n~ clmlt <br /> <br /> Each }i~ or <br /> Signal ~ult(s) <br /> <br /> Pack of I0 la~s <br /> <br /> ~ A* m~Mmd ~ Building Officio <br /> <br />5. FEES <br /> Al. Bnter total of fees from Sec, ~4 <br /> A':', Add 5% sutchaqle (,05 x A 1 ) <br /> <br /> Subtotal <br /> <br /> B, Enter ~% of line A1 for~anRevicw <br /> (s~. 3), ff ~ <br /> C. ~vestjga~ Fee (ff ~d) <br /> D, Rc~s~fi~ Fee ~,~) <br /> <br /> ~TAL AMOU~ DUE <br /> <br />Receipt No. <br /> <br /> <br />