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IFOR OFFICE USE ONLY <br />Received by: <br /> Date: _ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588.5147 $:00 am - 4:3tyro <br /> Code-A-Phone: 588-7904 <br /> FAX: 5SS-~94S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 throu~ <br /> <br />Permit No. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />t. Locxno OWN ^LLATION AU$ <br />$obAddr~,, 11373 Mill Creek Rd. <br /> <br />city Aumsvi 1 le c~o,, s,. <br /> <br />Directions <br /> <br /> I)LE AND <br />BXPIRE IF WORK tS NOT ..qTARTED WITIUN 180 DAYS OF ISSUANCE <br />OR IY WORK IS SUSPFm,NDBD FOR 1 ~.0 DAYS. <br /> <br />2A. CON'I'RACI'OR INSTALLATION ONLY <br />m~td'~lCo, u,¢,or Alltec Security <br /> <br />Pbo"':503/331-262, <br /> <br />Ma~ngAddm"P0 ~OX 55310 - Portland, OR 97238-53 <br />mo~nyO~n~ Santiam Homes I1'h~769-774~ <br />Co.,,ac~o~, U~a,e ~o. 26-307CIE <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />MaiLing Address phone <br /> <br />City/State/Zip <br /> <br />Th~ installation i~ being made on property I own which is not intended for sale, <br /> <br /> Owners Sisnature <br /> <br />"3. PLAN REVIEW SECTION <br /> <br />We will provide plna reviow service if you complato S~fion <br />515 and submit two (2) sols of plans and specifications wiuh <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 />SpeeiaRy Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />~'r~ Residential Per Unit {' <br /> [~r~ice Included: hems Cost (each) Sum <br /> <br /> tl~ sq. h. or less $85.00 .... 4 <br /> Each ad~6ottal 5~) ,q. h. <br /> or ~di~ d~creof $15.00 <br /> L m ~ed ~ne~y $20.00 ~-- I <br /> <br /> 200 amps or les~ $35.00 2 <br /> 201 aaxpa to 400 *mpa $40.00 <br /> <br />a)The, f,~ fo~ branch cbcuit~ <br /> ourcha~c of sc~i~ or <br /> <br /> F4gb brach cJrcui~ $2.~ <br />b) ~e f~ for branch drcu s 3v 9u <br /> <br /> FJret branch c}rcuit <br /> Each additional branch ~ircull $2.00 <br /> <br /> Each pure ~ or ilrlgnfioa circle . . $40.00 2 <br /> Each ~ign or ou~nc light~g _ _ $40.00 <br /> Signal c~uit(s) <br /> <br /> a~ve. per tn*p¢~io, $35.00 <br /> Pack of 10 la~ls ~ $5.00 ~ $50.00 ...... <br /> <br /> (As required by Building Offic~l) <br /> <br />5. FEES <br />Al. Enle* tolal of fees f,om Se~ #4 $ 4 0.0 0 <br />A2. Add 5% surchargu 605 x A I) $ <br /> <br /> Subtotal <br /> <br /> B, Entez ~ ~ of fine A 1 for Plan R:viuw <br /> (S~. 3), if req~ <br /> C. Inv~HgationFee (drequ~ed) <br /> D. Re~s~cfi~ F~e ($~.00) <br /> 1o'rALAMo~'r DUE $ 42.00 <br /> R*~dD N2,. ....... <br /> <br /> <br />