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FOR O~FFICE USE ONLY <br />R6~4~%d by:~ <br />Date:~.~.~__ <br /> <br />F ELECTRICAL PERMIT APPLICATION <br />l Please complete all Sections, 1 through <br /> <br />MARION COUNTY BUILDI'NG INSPECTION <br /> 220 High Strut NFe <br /> Salem, Oregon 97301 <br /> <br /> phooe 588-5147 8:00 ~ - 4:]~ <br /> ~-A-~: 5SS-7~ SITE ~: <br /> FAX: 588-7948 <br /> Date: <br /> <br />pl~vlTI~ ARE NON-2~Rd~SIzT61L~BLE AND NON-KEFUI~)AB LE AND <br />EXi~IRE IF WORK IS NOT :STARTED 'NI' ~31q IS0 DAYS OF I~SUANCE <br />OR IF WORK IS SUSPENDED FOR 1BO DAYS, <br /> <br />2A, coNTRACTOR INSTALLATION ONLY .. , <br /> f <br /> <br />p~i~ay Owner <br /> <br />Contractor's License No, <br /> <br />Ccatractor's Beam Reg. No. <br /> <br />Signature oi $~S~r~ising Electdcian <br /> <br />Supc~4~ur's Li. cen~u <br /> <br />Owner's $ignam~ __ <br /> <br />PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Sectio~ <br /> 5B and submit two (2) sets of phns and specifications wi~ <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 Stmctnral <br />. Specialty Code, Chapter 53. <br /> <br />Issued by; <br /> <br />Permit No, <br /> <br />4. FEE SCIIEDUt. E (CompleTe and ~nter total in A I below) <br /> <br />A- R~ldenflal Per Unit B~x~ Cost (~eh) Stun ' <br />Semite included: ' <br /> <br /> $85,00 .... 4 <br /> <br /> ~ M~agd ~r M~¢ar <br /> Dwelllng~ F~der ~' $40.~ <br /> <br />B. Ser~ or F~der$ (~s not ~l~flc ~noh el m~% ~ee ~ecd~ D) <br /> ln~lh~o~ AIt~a~ons <br /> <br /> ~1 ~ ~ ~P~ <br /> <br /> R~ ~ly $40 <br /> C. Tem~y Servicings <br /> <br /> ~t ~ to ~ <br /> ~r ~ ~ps or 1~ volts <br /> <br /> D. ~ranch <br /> <br /> a) ~e f~ for blanch <br /> <br /> b) ~e f~ for ~nch drcms <br /> a~, ~r ~on ~ $~.00 ., <br /> <br />Al. Fm~r total of fees from Sec, #4 <br />A2, Ad<l 5% sumhalge (,05 x <br /> <br />B, Emer ~% of fine Al for Plan Review <br />C. ~vesfiga~on Fee <br /> <br /> ~AL AMOUr DUE <br /> <br />$ <br /> <br /> <br />