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FOR OFFICE USE ONLY ] MARION COUNTY BUILDING INSPECTION <br /> <br />Received by: [ 220 High Street NE <br />Date: ~ Salem, Oregon 97301 <br /> Phone 585-5147 $:00 <br /> <br /> ELECTRICAL PERMIT APPLICATION Date: <br /> Please complete all Sectiona, I throug/~l ,SEP 2_ .!1 T19CJ7 ~ssueo by: <br /> <br />Perrni[ No. <br /> <br />~. l.oc,mo,~ IVlARION <br />~obA~. 121 Ehlen Rd <br />City Aurora / C,~,s S,. <br /> <br />Dh'c¢fion~ <br />L~scdption <br /> <br />PERMITS ARE NON-TRANS FERABLF. AND NON-I~EFUNDABLE AND <br />EX,IR E IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br />ElectdcalCor~tra¢10r Alltec Sec~ity ~31-262 <br />~'~ga~Om"PO ~x 55310 - Portland, OR 97238-53 <br />Pro~nyO~r Bird Brains ~ <br />~...~, u~,~ No. 26-307~E <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />7'he imtaUafion is being mada on properly I own which is not hi[ended for sale. <br /> <br />Owner's Signature _ <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provldo plan review service if you complcto Sec don <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br /> This optional plan review pregram does not suspend the <br /> required submission of lighting power calculations, plans, <br /> and specifications when requited by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />COU <br /> <br />200 stops or less ---- $50.00 . - 2 <br />201 amps to 400 arnps $60.00 2 <br />4OI amps to 6IX} amps $100.00 . 2 <br /> <br /> $80 <br /> panel, alteradon or exte~slon .] $40.00 ~1-. (~ C <br /> <br />5. FEES <br />Al..Enter Iota] of fees from See.//4 $ 40. 0 0 <br />A2. Add 5% surcharge (.05 x A l) $ <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Ftevicw <br /> (Sec. 3), if requh-ed <br /> C. Invesd§ation Fee (if required) $ <br /> D. Reinspecfion Faa ($25,00) $ <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Recc!M No. <br /> <br />$ 42.00 <br /> <br /> <br />