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FOR 0'Fh~ USE ONLG' MARION COUNTY BUILDING INSPECTION <br />I Received by: <br /> Date:. Z 7 <br /> <br /> 220 High Street NE <br /> Salem, O~egon 97301 <br /> <br /> Phone $$$-5147 8:00 ~¢n - 4:3~m <br /> ~e-A-~e: 5BB-7~4 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please ~mpleto atl Sections, 1 through 5 <br /> <br /> Permit <br /> SITE#: · nt~* ,~ <br /> "", <br />· Date: --- <br />...... ~ ....... "~or~OllON <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />PI~MH$ ARB NON -TRAiqSFRRAFII,E AND NON-RI~ABI~ Ah*D <br />FDO~IRE 1~ WORK IS NOT STARTED W1THIN 180 DAYS oF ISS,,UAaNCE <br />OR IF WORK IS SUSPElqDED FOR, 180 DAYS, '~ <br /> <br />2B. FOR O~ER IN~ALLATIONS <br /> <br />Pro~y Owner <br /> <br />Mailing A&drcs~ I Phone <br /> <br />C'Jty/SlstefZip <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review s~rvice if you complete Section · <br />5B and submit two (2) ~ts Of plans and specifications with <br />this application. <br /> <br />This optional plan review Program doe~ not suspend the <br />required submission of lighting power calculations, phns, <br />and specifications when required by the Oregon Stmcttwal <br />Specialty Code, Chapter 53, <br /> <br />4, FEE SCHEDULE (Complete and ~ter to~ in Al I~low) <br /> <br />A, Residential Per Unit <br /> Service lectude~: <br /> <br />N~mber d Imp~t{~s p~ permit <br /> <br /> $B5.0o <br /> <br />10(10 sq, ft. or less <br />Each addifioixal fiDO s~, <br />~y $20.00 <br />E~ M~fd Hom~ orM~r <br /> <br /> l~lhtlon, Ml~fiOns ~ Rel~atlon <br /> ~ ~ ~ less <br /> ~1 ~m~ ~o 4~ amps ~ $~.00 <br /> <br /> R~ ~y 840.00 <br /> C, ~m~rary ~e~le~ders <br /> <br /> 201 ~p~ to ~ a~ $~0,00 <br /> 401 ~ps ~o ~ am~ <br /> ~er ~ ~ps et 1~ vol~ <br /> <br /> D. ~raach CI~ulL~ <br /> a) ~e f~ f~ ~an& dr~ts wi~ <br /> ~eh brach ~ui~ $2,~ <br /> b) ~e f~ for ~nch <br /> <br /> Fire b~nch clmuk $35,00 <br /> ~ch addifi~ branch ckcuit $2.~ <br /> <br /> E, M~cel~n~us (Service or Fee~er N0. Included) <br /> ~¢h ~mp or i~gafi~ cimle ~ $40,00 <br /> ~ch sign or ~o liebig ,., $40.00 <br /> Sign~ ~/t(s) or a ~ ~e~y t <br /> ~nel, ah~mfi~ or cxtcnsio~ ~ -., $40,00 <br /> <br /> F. Each a6dttlo~al l~s~tiOn ' <br /> ~er ~C agowable <br /> a~. ~r ~s~cfi~ $35,00 <br /> <br /> G+ Minor lns~llation Labels <br /> Pack of 10 la~ls <br /> (so~ only tO electrical co.ratters) <br /> <br /> H. Other <br /> <br />5. FEES '" <br /> Al. F. mer t0.al of fees from Sec. #4 <br /> A2. Add 5% surcharge (,05 X Al) $ <br /> <br /> B. En~r~%of~eAl forHan Re~ew <br /> <br /> D. Reh~fi~ F~ ~.~) <br /> <br /> ~TAL ~O~ DUE <br /> <br /> <br />