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OFFICE USE ONLY <br />Reeelv~d by:._~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />L IA3CATION OFINSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> Pho~c 588-3147 8:00 am - 4:30pm <br /> C~le.A-Phonm 588-7904 <br /> FAX: 588-7945 8~TE ii: <br /> <br /> Date: <br /> <br />I pERMFCSARENON.TRANSFER~BLEANDNON-REFUNDABLEAND ;, <br /> EXPIRE IF WORK IS NOT STARTED WIII41H 180 DAYS OF ISSUANCEI <br /> OR IF WORK 1~ SUSPE31DED FOR 180 DAY,g, ; <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br />I lme~i:alCm~ctor A,.lli.ance Elec. IPi'°=591-,,2222 <br />I MailingAddmss 19590.5W 51st Tualatin 97062 <br /> <br />2~. FOR OWNER INSTALLATIONS <br />Propcr~ Ownor <br /> <br />Mailing Address <br />Oty~tate[Zip <br /> <br />The installation is being mad= on property I own which is ~lcl intended ~or sale, <br /> <br /> Ownees Signature , <br /> <br /> 3, PLAN REVIEW SECTION <br /> <br /> We will provide pltm review service if you complete Section <br /> 5B and submit two (2) sets of plans and specificalions with <br /> this application. <br /> <br /> This optional plan review program does not suspend the <br /> required submission of lighting power calculations, plans, <br /> aud specificalions when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/9] <br /> <br />PermitNo. <br /> <br /> lssu~fl by: <br /> <br />4+ FEE SCHEDULE (Compl~tc and *nWr total in Al below) <br /> <br /> Numbea' of Ins~uilo~ p~ i~rmtt atlow~l <br /> <br />A. <br /> ResldentlM <br /> Unit <br /> Service Included: htxas Cost (each) Sam/ <br /> 10~0 ~q. fu or la~ · $~.00 <br /> <br /> e~ per6~n thereof $16.00 <br /> Limimd Bnemy ~ $20.00 ~ <br /> Each Manui~d Home or Moduhr <br /> Dwelling Servic~ or Feeder $40,00 -- <br /> <br /> E. Servio~ or Feeders (Do~ [tot ~ttc~de branch circuits, ~ section <br /> ln~allatlon, AR~-atlons or Relocation '1 ~ <br /> 200 amps or less $50,00 <br /> 201 am]~ to 400 ~nps $60.00 ~ <br /> <br /> 401 am]~ to 600 amps $~00,00 <br /> (301 amps to 1O00 amp~ ~ $130.00 <br /> Over 1000 ~aps or volts $300.00 <br /> Re~otme. ct ~ly . $40.00 ~ <br /> <br />C, Temporary <br /> <br /> 2~ ~ps or <br /> 201 ~ps to ~0 <br /> 401 ~ m ~0 am~ <br /> ...... <br /> a) ~ f~ f~ ~ ~rc~ts <br /> <br /> b) ~e f~ for ~eh ~r~s w~out <br /> <br /> F~t b~g~ ~g~t <br /> ~ ~di~ brach ~muit <br /> <br /> Signal ~it(i) or a <br /> <br /> Pack ~ 10 la~s <br /> <br /> ( As mq~red by BulMing <br /> <br />$35.00 <br />$40,00 <br />$80.00 <br /> <br />$2,00 <br /> <br />$38.00 <br /> $2,00 <br /> <br />$40,00 2 <br />$40.00 ~2 <br /> <br />$40,00 ~2 <br /> <br />$35,00 <br /> <br />$~0.00 <br /> <br />5. FEES <br /> Al. Enter total of fees from S¢¢. #4 <br /> A2. Add 5% mmha~e (.05 x Al) <br /> <br /> Submffi $ <br /> B, En~%of~aA1 for PI~ ~view <br /> <br /> C, hv~tiga6on F~ (ff mqui~d) $ <br /> D. R~ Fcc ($~.~) $ <br /> <br /> ~hL AMO~T DUE <br /> <br /> Recei~ NO. ,, , , <br /> <br /> <br />