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IFOR OFFICE USE ONLY <br /> ~eceived by:. <br /> Dat¢~ .......... <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> <br /> 220 High Stn?et NE <br /> Salem; Oregon 97301 <br /> <br />Phon~ 588-5147 8:00 ~n - 4:3~ <br />F~: 588-7~8 <br /> <br />I ELECTRICAL PE RMIT AppLicATION <br /> <br />t'"'" pERMylX3 ARB NON.TRA,NS FBRABLE A.ND NON.RE FUN.DAB LE AND <br /> <br /> BXFIRI~ 1F WORK IS NOT STARTBD 'ff~rl.~N 180 DAYS OP ISSUANCE <br /> OR IF WOP~K IS S USP]HqDED FOR 180 DAYS, <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />City/State4Zip <br /> <br />The ias~ailatioo is being made on p~rty I own which is 9o~ in~ded for aale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application_ <br /> <br /> This optional plan 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 Cole, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit NO, <br /> <br />4. FEE SCHEDULE (Complete a~d odl~r wtal in A 1 I:~low) <br /> <br /> Number of Inspoctions per perml~ allowed <br /> <br />A. <br /> R~lde~ti~ <br /> Unit <br /> <br /> 1~ sq.~ ~less $85,00 ..... <br /> ~h aa~mal 5~ Sq. <br /> ~ffi~ ~cmof $15.00 <br /> ~y ~ $20.00 <br /> ~ ~aFdHome or M~uhr <br /> ~wv~ S~ or Feed~ .. , <br /> <br />B. S~ or ~eeders ~es no~ ~d~ b~an~ ~t~, see suc~ D) <br /> l~}ation, AIt~a~$ <br /> 50.00 <br /> ~ am~ or less <br /> <br /> C, Tem~rary Servl~ <br /> <br /> purchas~ 9f se~ <br /> <br /> Bach addiQ~ b~ ~t $2,~ <br /> <br /> ~a~ ~p or ~gafi~ <br /> ~ch ~ m ~ ~g _ $40,00 <br /> Sign~ c~ui~m) or a ~ted ~e~y <br /> ~el, ~mrati~ or cxt~ ~ $40,00 <br /> <br />E ~eh additional lnsp~tl~ <br /> <br /> Pack of 10 la~s <br /> <br /> (As mq~red by Bu~g~g O~c~O <br /> <br />5. FEES <br /> Al. Enter total of fees from Scc, #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 2~% of ~ne Al for ~n ~view <br /> (S~, 3), ff mqulr~ <br /> C, ~v~dgation Fee (ff mqulmd) <br /> D. Re~s~cfi~ Fee ($~,~) <br /> <br /> TO't%L AMOU~ DUE <br /> <br />$ ~ '~ <br /> <br />Receipt No. <br /> <br /> <br />