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[FO]~ OFlfICE USE ONLY <br />Received by: <br /> <br /> S <br />MARION COUNTY BUILDING INSPECTION <br /> <br />Phone 58S-5147 8:00 a'n - 4:301~a <br />Ce~-A-Ph~: 539-7904 <br /> FAX: 588-7945 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete afl Sections, 1 through 5 <br /> <br />1. LOCATION OF INgFALLATtON <br /> ........,, <br /> <br />F~'I'S ARE NON-~NS~B~ ~ NON-~AB~ ~ <br />E~E ~ WO~ IS NOT ~ART~ ~ 180 ~AYS OF ~SU~CE <br />OR IF WO~ IS $U~ED FOR 180 DAYS, <br /> <br />Salem, Oregon 97301 <br /> <br /> SITE #: ~ <br /> JUN 06 1995 <br /> Date: MARION COUNTY' <br /> issued by: mm <br /> .... ~,,~u hN'SPE¢'t tON <br /> <br /> Nurober ~ Insp~lons p~ permit all0w~ <br /> <br /> A, <br /> ~r <br /> UnR <br /> / <br /> <br /> Ea~ ad~ 5~ sq. ~ <br /> ~ ~y $~,oo 1 <br /> <br /> Dw~ng Se~ or F~er ~ $40,00 ., <br /> <br /> B, S~ or FeVers ~s not inlcude ~n~ ~, sca ~cdon <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br /> Mail~ng Add.ss <br /> ill ..,/ <br /> <br /> c~,,~c~r, u..,,, No. . ,~ ~/~ ~ ¢ <br /> <br /> Signatu~ ~ Su~i~g <br />............ <br /> <br />FOR OWNER INSTAL/~TIONS <br /> <br />Mailing Addross <br />City/~[at~/Zlp <br /> <br />The inatalla6on is being made ma property I own which is not in~nded for ~ale, <br /> <br />PLAN REVI-EW SF. CI'ION <br /> <br />We will provide plan review service ff you ~omplem Section <br />5B and submit two (2) sets of plans and specifications with <br />this applicatioe. <br /> <br /> This optional plan review pzogram does not suapend the <br /> required submission of lighting pewer calculations, plans, <br /> and specifications when required by the O~gon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-$4 <br /> <br />InStallation, Alterations or R~tocatlofl <br /> <br /> 201 amps to 400 amps <br /> <br /> ~01 arops to 1600 amps <br /> <br /> P,~cotm¢ct oaly <br /> <br />~er ~ ~ps or 10~ volts <br /> <br />N~, AR~atlon, or ~tenslon ~r <br /> <br />b) ~e f~ for ~ ~ts <br /> ~s~of s~ or f~d~ <br /> <br />Ml~l[an~us (S~rvl~ ~ F~r Not Include) <br />( A~ ~q~red ~ BuiMi~ Offlc~l) <br /> <br />Al. 'Enter tot-1 of fee~ from Se~- #4 <br />A2. Add 5% aurcha~c (-0~ x Al) <br /> <br />B, ~er ~% of ~ kl fo~ ~an <br /> <br />C. hve~onFee ~ mqu~d) <br />D, R~s~fi~ Fee ~.~) <br /> <br /> TOTAL AMOU~ DUE <br /> <br />Reeei~ <br /> <br />60.00 2 <br />$100,00 ~2 <br />$130,00 ., 2 <br /> <br /> $40,00 ~2 <br /> <br />$35.00 2 <br />40,00 2 <br />~80,00 .., 2 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40,00 2 <br /> <br />$35.00 <br /> <br />Sso,oo <br /> <br /> <br />