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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St. NE - Room 132 <br /> Salem, O~gon 97301 <br /> Phnne 5~8-5147 8.'00 mu - 4:301xn <br /> Code-A-Photo: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION [ <br />P/ease complete all Sections, 1 through 5 <br /> <br />SITE #: ~,( <br /> <br />Date: ..~,,n., t~fll I ILITV <br /> <br />Issued by: BUILDING INSPECTION <br /> <br />(LOCATION OF INSTALLATION <br /> <br />P~TS ~ NON-TP~,NSFEP~BLE AND HON-I~FUNDABLE AND <br />EXPW~ ]~ WORK ZS ~OT STARTED ~ 180 DAYS OF <br />OR H~ WORK ~ SUSPEHDED ~ ~80 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Centraaor ] Phone <br /> <br />Ma/~ng Address <br /> <br />Contractor's License No. <br /> <br />Contractors Board Reg. No. <br /> <br />Signature of Supervising Mectrician <br /> <br />Sut~.wisor's License No. <br /> <br />.FOR OWNER INSTALLATIONS <br /> <br />Job No. <br /> <br />[Ph~e No. <br /> <br />The imalhfion i~ be. in~.~ade on prop~ty I own whid~ i~n~t htmded for stle. <br />3. PI~N RI~NIEW SF_X~TION <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 Code, Chapter 53. <br /> <br />MC 15-34 8/94 <br /> <br /> 4. F~E ,~i~.,DULE (Complete and enter total in A1 ~ow) <br /> Num~ ~ l~s p~ ~it a~ ~ <br /> A. <br /> UMt <br /> / <br /> ~ ~d~: ~s Cmt (~) <br /> 1~ sq. ~ ~s $~.~ 4 <br /> <br />  m ~f . $15.~ <br /> <br /> ~1 ~ m 1~ ~ $1~.~ 2 <br /> ~r 1~ =ps ~v~ ~.~ . 2 <br /> ~.~ ~ 2 <br /> <br /> ~~ AIm~, ~ Rd~n <br /> ~l~w~ ~.~ __ 2 <br /> <br /> ~ b~ ~t $~.~ . , <br /> <br /> b) ~fmf~~ ~m <br /> ~e of ~ ~ f~ f~ <br /> <br /> ~ ~ ~t $~.~ <br /> <br />~ ~lanms (~ ~ F~ N~ ]~iuded) <br /> <br /> ~er~e ~able ~ ~y of ~e <br /> <br /> G. Mi~ ~lla~ ~ <br /> P~ ff 10 la~ ~ ~.~ ~ $~.~ <br /> <br />JFEES <br /> <br />Al. Enter total of fees from S¢~ #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% ofhneA1 forPlan Review <br /> (Sec. 3), if ~4uired <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOLrN'r DUE <br /> <br />Receipt No. <br /> <br />$ <br />$ ~, s'o, <br />$ qq.,5-o <br /> <br /> <br />