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ONLY <br />Received by: <br />Date: ' <br /> <br /> MARION COUNTY BUILDING <br /> <br /> ~e-A-~: 588-7~ Pe~it No, <br /> F~: 5SSJ94S SITE <br /> ~ARION COUNTY <br />ELECTRICAL PERMIT APPLICATION B~iNG iNSPECTiON <br /> <br />Please complete all Sections, I through 5 <br /> <br />1, LO~ATION OF INSTALLATION <br /> <br /> ..... <br /> <br />P~F~ ~E NON-~SF~B~ ~ NON-~AB~ ~ <br />~E ~ WO~ [$ NOT STATED ~ 180 DAYS OF ~SU~CE <br />OR IF WORK I~ SUS~ED FOR 180 DA~, <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br /> ......... <br /> <br />...... ...... <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Propeay Owner <br /> <br />Mai~g Address [ Phone <br /> <br />City/State/Zip <br /> <br />The imtallafical is being made o~ property I own which is n~ intendc4 for sale, <br /> <br />Owoet's Signature ...... <br /> <br />3. PLAN RE¥1EW SECTION <br /> <br /> We will provide pl~ renew s~vic¢ if you comple~ S~don <br /> 5B and submit ~o (2) se~ of plans and ~ffi~fions wi~ <br /> this applkation, <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 Cede, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br /> Issued by: <br /> <br />4, FEE SCHEDULE (Coroplem ~d entc, r total in A I below) <br /> Numbe~lnspections p~r perrol, allowed ] <br /> <br />1~ sq, ~ ~ le~ ~5,00 4 <br /> <br /> m ~m ~*~of $15.00 <br />~d gne~y .... $~0,00 <br /> <br />B, Se~ or Feed~ ~s not ~de ~ch civets+ see s~don D) <br /> <br /> 200 arops or l:sa <br /> ~01 amps to 4~ <br /> ~I ~ m ~ arops <br /> ~1 am~ m 1~ ~ps <br /> <br /> R~ect <br /> <br />C. Tem~r~y Servl~fl~s <br /> <br /> 2~ ~ps or <br /> 201 ~ps to <br /> 401 ~s ~o ~0 <br /> ~e~ ~ps or 1~ volu <br /> <br />D. Branch C]~ui~ <br /> <br /> ~rchage of ~e~ ~ fe~er ~ <br /> <br /> b) ~e f~ for ~ch ~muts ~t <br /> <br /> Each a~difi~ b~nch <br /> <br />E. MIs~llan~us (Service or Fe~ev Not Included) <br /> <br /> Sign~ ~(s) <br /> <br /> ~, ~r ~c6on <br /> <br /> ( A* mq~md ~ BulMing Officio <br /> <br />SO,O0 <br />~60,00 <br />$100.00 <br />~130,00 <br />300.00 <br /> $40.00 <br /> <br />$35,00 <br />$40.00 <br />$80.00 <br /> <br />$2,00 <br /> <br />$2.00 ... <br /> <br />$40,00 ~2 <br />$40,00 ~2 <br /> <br />$40.00 <br /> <br />$a5.oo <br /> <br />$,50,00 <br /> <br />5. FEES " <br /> Al, Enter trial of fees fmro Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Emer~5%oflhleA1 for ~Review <br /> ~, 3),if ~q~ <br /> C. hvesfig~ion F~ (ff required) <br /> D. ~ns~c~m Foe ~.00) <br /> <br /> ~TAL ~O~ DUB <br /> Receipt No. ~ ,, <br /> <br />$ _7b <br /> <br />$ ~ ' <br /> <br /> <br />