Laserfiche WebLink
FOR OFFICE USE ONLY <br />Received by:. ,~ <br />Date: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> Salem, Oregon 97301 <br /> <br /> StTE#: <br /> <br />IELEOTRIOAL PERMITAPPLIOATION <br />Please complete all S~!ion$, I through i5 <br /> <br />1, L~CATION OF INSTALLATION <br /> <br />I~rcctions <br /> <br />Descrip~/on <br /> <br />PERMITS AR]~ NON-TRANSFERAbLE AND NON-KEFUN~BLE AND <br />EXt~IRE IF WORK IS NOT STARTED W1THIN 180 DAYg OF ISSUANCE <br />OR IP WORJ( I$ SUSPENDED FOR 1 g0 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />03-2.2-3 <br /> <br />Signature of Supervisin$ FA*etfidan <br /> <br />2B. FOR OWNER INSTALL~TION$ { <br /> i I <br />Mailing Address Phone <br /> <br />City/State.Ap <br /> <br />The mstallatloll ~, Being made on proi~-y I own which is nol:int~nded for sale <br /> <br />Phone 588-5147 8.'00 ~an - 4:30pm <br />Co~e-A-Ph~e: 588-7904 <br /> FAX: 588-7948 <br /> <br />te Section <br />0ns with' <br /> <br />Owners $~gnamm ,, ,, <br /> <br /> PLAN REVIEW SECTION ' <br /> <br /> We will provide plan review service if you ~omP1~ <br /> 5B and submit two (2) sets of plans and speciftcat <br /> this application, <br /> <br />This optional plan review program does not suspeud the <br />required submission of lighting pOwer calculations, plans, <br />and specifications when required by the Oregoh StrUctural <br />Specialty Code, Chapter 53. <br /> <br />MC 15.34 11191 <br /> <br /> Date: MA~[g,~"~OUNIY <br /> ~ssued b~,Ultl)ING INSPECTION <br /> <br />4. FEE SCHEDULE (Comtflete ~d ~mr to~ ~ A I ~low) <br /> <br />A. <br /> R~dentl~ <br /> Unit <br /> S~lce Include: g~s Cmt (e~h) Sum/ <br /> <br /> 1~ ~q, ~ ~ss $85,00 4 <br /> <br />B~h M~uffl Hme or M~ular <br />Dwe~ng $e~ or Fe~er $40.00 <br /> <br />B, ~er~¢~ O~ Fee~ers ~$ not ~ude b~ ~rc~ <br /> Ia~ hflon; A ~at oas ay <br /> <br /> 201 amF~ m 4~0 amps <br /> 401 am[~ to 600 amps <br /> ~1 am~ m 1~0 am~ <br /> ~er 1~ ~ps or vol~ <br /> <br />C. ~m~rary gervlc~d~s <br /> <br /> g01 ~ps w ~0 ~ps <br /> 401 ~ps ~ ~0 ~ps <br /> ~er ~ ~ps or 1~ vohs <br /> <br />D~ Branch <br /> N~, Al~a~on, or ~msion ~r Panel <br /> <br /> ~aoh bm~ ~uit <br /> <br /> b) ~e f~ f~ <br /> <br /> ( As ~q~rtd ~ BuiM~ OffaaO <br /> <br />5, FEES <br /> <br /> A2. Add 5% mmha~ (.05 x A 1) <br /> <br /> C, ~ves~afi~ Fee (ff ~quired) <br /> D. Re~s~ Fee ~.~) <br /> <br /> ~50.00 <br /> 60,00 <br />$1oo,oo <br />$130,00 <br />$300.00 <br />$40,00 <br /> <br />$35.00 2 <br />~40,00 2 <br />80.00 __2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $3,00 <br /> <br />sao.oo <br />$40.00 <br /> <br />$40,00 <br /> <br />$8S.00 <br /> <br />$50.00 _, <br /> <br />Receipt No, <br /> <br /> <br />