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FOR OFFICE USE ONLY: <br />Received by:_ <br />Date: <br /> <br /> FAX: 588-7948 <br /> <br /> Please complete all Sections, I through 5 J <br /> <br /> t. LOCATION OF INSTALLATION <br /> <br />PEILMrFs ARE NON.]YRANSFI~RASLE AND NON-t~EFUNDAB LE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN lan DAYS OF ISSUANCE <br />OR IP WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />Mai.~lg Addr~as , <br /> <br />2B; FOR OWNER INSTALLKI'IONS <br />Property Owner <br />Mailing Address Phoue <br />City/Stale/Zip <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Wc will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <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 Structtteal <br />Specialty Co(lc, Chapter 53, <br /> <br />MC 15-34 11/91 <br /> <br />MARION COUNTY BUILDING <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8;00 am - 4:30pm <br />Code-A-Phone: 588-7904 <br /> <br /> MARION CObg }; it No, <br />SITE #:~[~[Ob'~ i~S?ECTION <br />Date: <br /> <br />Issued by: <br /> <br />4, ~E SCHEDULE (Comp]ata amd enter total in A 1 below) <br /> <br /> serqcelnC ude¢:Residenga/iPerUnaNumber of Insp~tions p~ permit allowed <br />A, <br /> It--s Cosi (each) Sum-- <br /> <br /> $85,00 __ 4 <br /> 10~ sq. ft. or Ic~ <br /> Each ad~fi~al 5~ sq. fl. <br /> ~ ~ thereof ~ $15.00 <br /> L~tcd Enemy $20,00 ~ 1 <br /> <br /> Dwe~ag ScUm or Feeder ~ $40,00 <br /> <br />~. Ser~s or Feeders (D~s not ~nlcudc branch ~ts, se~ s~cdon <br /> <br /> ~ amps or Icss ~ $50,00 __ 2 <br /> ~] amps to 4~ ~ps $60,00 <br /> ~1 am~ to 6~ amps $100.00 <br /> <br /> ~er 10~ ~ps or volts $300,00 <br /> Rc~ncct ~ly ~ Sa0.00 __ 2 <br /> <br />C. T, mporary Servlee~4ers <br /> <br /> 2~ ~ps or less $35.00 -- <br /> 201 ~ps to ~0 amps $40.00 <br /> 401 amps to ~0 amps $80.00 <br /> ~er ~0 amps or 10~ volta <br /> <br /> a) ~ f~ for ~anch ~ts ~ <br /> purc~a~e,p(.s,~ or fe~er fee <br /> <br /> Each brmch cimui[ $2.00 <br /> b) ]~e f~ f~ branch ~rcuts without <br /> <br /> ~¢r ma a~owabl~ Jn any of ~ <br /> a~ve, per ~sp¢ctlon $35,00 <br /> <br /> (sold only to e&ctrical comractors} <br /> <br />5. FEES <br /> <br /> Al. Enter ~otal of fees from Sec, #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of lineAl tbr Plan Review <br /> (Se~, 3), if reqoi~eA <br /> C, hlvcstigationFee (if required) <br /> D, ReinspeCdon Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, -- <br /> <br /> <br />