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FOR, OFF!JZE US~. ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDiNG INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8.'00 aa - 4:30pm <br /> Cod~-A-l~n~1 588-7904 <br /> <br />ELECTRICAL PERMIT A.PPLICATiON <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OFINSTALLATION <br /> <br />~E ~ WO~ ~ NOT ~ ~ 180 DAYS OF <br />OR ~ WO~ IS SUSP~ FOR 180 DAYS, <br /> <br /> CONTRACTOR INSTALLATION ONLY <br />E]e~rlcalC0n~or JUDSON'S) TNC. ,.[l~n~ 363-4141 <br />M~U~g^da~ PO BOX 12669 Salem, OR. 97309 <br /> <br />~¢~s M~ No. 24-18C <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Pvot~t Owner <br /> <br />Marling Address <br /> <br />Chy~atet'Zip <br /> <br />Th~ installaaon i~ b~kag ma~ oa ptol~rtr I ow~ whi~ i~ n~ int~:lnd for sale, <br /> <br />O,~a~fs Sign,~tum ..... <br /> <br /> PLAN REVIRW SECTION <br /> <br /> We will provide plan rex4¢w s~t'vic¢ if you Compl¢~ Seetion <br /> 5B and submit two (2) sats of plans and specifieatiorls with <br /> this application. <br /> <br /> This optional plan r~view program does not suspend the <br /> required submission of lighting power calculations, plans, <br /> and specifications when required by thc Oragon St~uctucal <br /> Specialty Code, Chapter 53. <br />MC 15.34 11/91 ..... <br /> <br />Date: <br /> <br /> issued by: <br /> <br />4. i~E SCHEDULE (Cornpl=to and ¢~t~r total m A 1 below) <br /> <br />Each ~liTonal 500 sq. ft <br />or pcmo~ thereof ~ $15.00 __, <br />~d F.t~y $20,00 1 <br /> <br />Eae~ Martell4 Home et Medlar <br />Dw~l~g Se~m or Fced~ ~ $40.00 ~ 2 <br /> <br />B. S~ or F~e~ ~s not ~ b~n~ mrc~, Sec secdo~ D) <br /> <br /> ~1 ~ ~ ~ ~p~ ~ $~.00 2 <br /> ~1 ~ ~mp, ~ $~00.~ ~ 2 <br /> ¢1 ~ m 1~¢ . $180,~ ~ 2 <br /> ~ 1~ m~ or vol~ $800.~ ....... 2 <br /> R~mm ~y $~.00 2 <br /> <br />C. Tem~ra~ <br />2~ ~ps or~s $3500 2 <br />401 ~pa to ~ ~ .., <br /> <br /> b) ~e f~ for ~ <br /> <br /> ~ ~ or ~c ~h~g $40.00 -- 2 <br /> ~r~ ~owabl~ <br /> <br />R. <br /> ( ~ mq~red by Bu~g Offic~O <br /> <br /> 5. FEES <br /> <br /> A2, Add 5% s~ha~ (,05 x Al) $ <br /> Subtoml , $ <br /> <br />Rgceipt No, ,,, <br /> <br /> <br />