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IFOR OFFICE US~ 'ONL~ ~ MARION COUNTY BUILDING INSPECTION <br /> Received by:_ <br /> Salem, Oregon 97301 <br /> <br /> _ <br /> ELECTRICAL PERMIT APPLIOATION <br /> Please complete all Sections, I through 5~ OCr I /~fissued by' · - <br /> ...... _ ' - <br /> ~, Loc.'r~o~ O~'~TmN, -, 8UILDIN~ i/, <br /> <br />PERMEI'S ARE NON -'fB. ANSFERABLE AND NON-RBFUNDABI~ <br />EXPIRE IF ~OKK I5 NOT STARTED ~ lg0 DAYS <br /> <br />p reims/O~n~r <br /> <br />M*i]ing Address ] Phone <br /> <br />iT ~ I~EE SCHEDULE (Complete and ruler to~l in A 1 below) <br /> <br /> A. R~d~tial ~r U~it <br /> <br /> Each addi~ S~ sq. f~, <br /> ~ ~y ~ $20,~ <br /> <br /> ~ ~,~ ~ ~o oo <br /> ~1 ~ps ~ ps ,, $~',0o <br /> <br /> ~ amp~ or'ss ~ <br /> <br />Cily/~t atcf'Zip <br /> <br />a) Thc fee for branch eircni~,s,2~l <br /> <br />b) The f~ for branch dmnts wlt~.out <br /> ~rc~asc of sc~det ~ <br /> <br />Tbe installation is being ma¢le on p~ny I own which is no~/mended for sala, <br /> <br /> ~aeb. pump or ~fim c~cle . <br /> ~ s~n or ou~ne hght~g . <br /> <br />~O aOQit}onal Inaction <br /> over ~e ~owabl* ~ any of ~e <br /> <br />3. PLAN REVIEW SEC'fi'ION <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 ~sper~d the <br /> required submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structmtl <br /> Spcci,'dty Code, Chapter 53. <br /> <br />MC 15.34 11/91 <br /> <br />Pack of 10 labels ~ gS,O0 ca& ~ <br /> <br />$2.00 _ <br /> <br />$~5,00 <br /> $2.00 <br /> <br />$40,00 = : 2 <br />SdO,O0 --2 <br /> <br />$40.00 . ~ 2 <br /> <br />$$5.00 <br /> <br />Al. Enter total ut fee~ fram Soc. #4 <br />A2. Add 5% surcharge (,05 x A 1 ) <br /> <br />B, En~r 25% of ~ A1 for Plan Review <br /> <br />C, hv~tion F~e (if ~qui~d) <br />D, R~sp~d~* F~e ($~.00) <br /> <br /> TOTAL AMOUhq' DUE <br /> <br />Recei~ No, ~ _ ~ <br /> <br /> <br />