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~ Receivr.~d <br /> Date: <br /> <br />MARION COU'NT¥ BUILDING iNSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24, Hr I~e~tion Line: $8S-7904 <br />Off'we: 588-5147 8:00a.m.-4:30p.m, <br />FAX ~ 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />JohAddrcss 11361 Hill Creek Rd. <br />c,,y .lbs,. Golf Cl <br /> <br />22/ Golf Clllb Rd. <br /> <br />Look For Stayton Ford. <br /> <br /> PF~TS ARI~ NON:TI~NSI~I~BLE AND EXI~IRE IF WORII IS NOT I <br /> STAR~ ~ 1~ DAYS O~ ISSUAN~ OR ~ <br /> W~ IS SUSPENDED FOR 180 DAYS, ,,, i <br />~. CO~RACTOR ~ST~LATION O~Y : <br />ElcctrlcalCoa[ra~i0r Crawford Electric ~e 769-943i: <br />M~ill~Add~lp*O. B~ 645 Stayton, Or 97383 <br />P~p=~y o~.er VGP ~ Phon: 363-5986 <br /> <br /> FOR OWIX~R II~$TALLATION$ <br />plOperly Owner ~l~prinl) VGP <br /> <br />MailiogAddre.~s P,0. ~OX 868 <br /> <br />City/St~t~aip Aumsville, Or 97325 <br /> <br />3. PLANREVIBW SECTION <br /> <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plato and <br />specifications with this appllcation. <br /> <br />PERMIT NO: ~ <br /> <br /> Date: I~lr <br /> Issu~W C~; _ <br /> <br />4. ~ ~D~ (~mplet6 and e~t~ <br /> <br /> R~id~tinl <br /> <br /> ~1 ampa to ~ am~ ~ $1~.00 <br /> <br />e, T~p~ary <br /> <br /> 2~ amps or loss $35.~ <br /> <br /> b) ~e fee f~ ~nch ci~uila <br /> <br /> Flint b~ch c[mult ~ $35.00 <br /> ~ addi~on~ br~h ~i~ua $1.00 <br /> <br /> ~h si~ or ou[J~e lighting ~ $~.00 <br /> Ow~ th~ allo~abl~ in ~ of ~¢ <br /> <br /> (~ ~quir~d by ~Tdi~ O~iM) <br /> <br />~. ~S <br /> <br /> ~. Add 5% su~har~ (.05 x A 1) $.~ <br /> Subt~aI <br /> <br /> (Sec. 3), if~qui~d $ ... <br /> D. Rcimpeet~n ~ ($25,~) $_ ,, <br /> ~T~ ~0~ D~ <br /> <br /> <br />