Laserfiche WebLink
Received by:. <br />Date: ~, <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. IX)CATION OFINSTALLAT1ON <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 22O High Strecl NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Codc-A-Ph~: ~85-7904 <br /> FAX: 588-7~$ SITE #: <br /> I Date: <br /> <br />Deacrlpdo~ <br /> <br />PERMrI~ ARB NON-TRANSFIERABLI~ AND NON-REFUnDABLE AND [ <br />EXPIRE 1~ WORK IS: NOT STARTED W1TI-IIN 180 DAYS OF ~S:UANCE <br /> I <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> COl?TRACTOR INSTALLATION ONLY <br /> ROGER S. WOLGO1 <br /> 41~ SUNBEAM eT. SE <br />M~;~ Ada~ss S~, OR 973~-1~9 <br /> <br /> FOR OWNER 1N$'TALLATION$ <br />Property Owner <br /> <br />Mail/ag Address <br /> <br />The im[alla6on is being mad~ on property I own which is net h~tende~l for sal~, <br /> <br />3. PLAN REVIEW $ECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B and submit two (2) sets of phas and specifications with <br /> this application. <br /> <br /> This optional plan review program does not suspend the <br /> required submission of lighting power calculations, phns, <br /> and specifications when required by the Oregon SI,mctaral <br /> Specialty Code, Chapter 53. <br />MC 15.34 11/91 " <br /> <br />Permit No. <br /> <br /> Issued by: <br /> <br />4. FEE SCHEDULE (Compl~ md ~nlrr total ~ Al <br /> <br />A. <br /> R~ldentlal <br /> Per <br /> / <br /> $e~l~ Included: It~ Cmt (~) <br /> <br /> Ea~ ~&~n~ 5~ sq. ft. <br /> ~ the~of 015.00 <br /> <br /> ~ng Se~ ~ Feed~ $40.00 2 <br /> <br />B. S~r~ or Fe~em ~s not h~ ~n~ dm~[% s~ ~fi~ D) <br /> Inflation, <br /> Al~aflons <br /> R~a/Io~ $~,00 ~ 2 <br /> <br /> ~ am~ ~ ~ $130.~ ~ 2 <br /> R~ct ~ly ~ $~.00 2 <br /> <br /> 2~ ~ps or less $~,00 ~ 2 <br /> 201 ~pa to ~ am~ $~0,00 ~ 2 <br /> <br /> ~[~ ~ps or 1~ ~ltf <br /> <br />D. Branch <br /> <br /> F~t branch ci~i[ · ~35,00 <br /> <br />E, M~ellan~us (~vlce or Fee~r N~ Inclgded) <br /> ~ ~mp ~ ~$aK~ C~ ~ ~0.00 ....... 2 <br /> <br /> ~r ~e ~abl~ M ~y ~ ~e <br /> <br /> Pack ~ 10 la~ ~ ~,~ ~ <br /> <br /> ( A~ ~q~d ~ BuiMing Off~l) <br /> <br />$. FEES <br /> A 1, Bm~r [o~al of fees from $~. #4 $ <br /> A2, Add 5% <br /> , :~o <br /> <br /> B, En~r ~% ~ llne A1 f~ ~ R~ew <br /> (5~. 3), <br /> C, ~v~figafionFee (ff mqM~) $ <br /> D, R~s~m F~ ($~,~) $ <br /> <br />...... Recei[~ No. <br /> <br /> <br />