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285 C~urch 8t NB Room <br /> FOR CITY VALIDA'D~O~ Salem, OR 97a01 <br /> <br />ELE~T~IGAL'~- - ~ PE~MITAPPLIGATION { ~ ~ <br /> Pl~se complpte ~1 ~tions, I throv~h 5 I ~ 4. <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR lg0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contmctor',Bo,rdReg. No. ~Oq [ { JobNo. <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Pt'opcfly Owner (please priff0 <br /> <br />Mailing Addr~as I Phone <br />Cify/StatdZip <br /> <br />3. PLANRBVIBW SIiCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if~ou com~iete <br />Section 5B and submit two (2) sets of plans and <br />spe.¢ifications with this application. <br /> <br />~ 15-34 12~4 <br /> <br />Servia, Included: <br />I000 sq. iL ~' less $85.00 4 <br />Each addilloual <br /> <br />L~i~d ~ ~0.ffi 1 <br />~ch M~feem~ Ho~ or Mod~ <br /> <br />B. ~ ~ F~a (~ ~t hclu~ ~nch ci~ see se~n D) <br /> <br />E. Miscellaneous (Service c~ pcedm Hot Indudet) <br />Each pump or in~ntion circle $40.00 2 <br />Each sign ec outline li~hlia$ f~lO.OO 2 <br />Sigaml ¢iguit(~) or a limile, d <br />panel, altm'aliog or ox~mio~ $40,00 2 <br />tm. {{,mb additio~al lmqmm~io~t <br />Over the allowaSle in any of tho <br />above, per Inspection S35.00 <br />O. Miaw In~allafioa Labels <br />Pa~k of 10 ialg~, ~ $$.00 ~ach $50,00 <br />(sold only ~o <br />H. Oth~ <br />(As requited b,. <br />Auro~ Dwelling <br /> Dwelling Permfl Label N/C <br /> <br />S. FEES / <br /> A 1. Enter total of tees from S*e. #4 <br /> A2. Add 5% su~harse (.05 x Al) <br /> <br />Subtotal <br /> <br />$ <br />$ <br /> <br />B, ~ter 25% of line Al for Plnn Review <br />(Sec, 3), if requital $ <br />C. Inves~gat~n Foe ({f~u~d) $ <br />D, ~/~o~ ~ ($25.~) <br /> <br /> TOT~ ~O~ DUE <br />Rec~i~ <br /> <br /> <br />