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Date <br /> <br />FAX: 588-7948 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OregO~ 97301 <br /> <br /> Plmn¢ 588-5147 8:00 ara - <br /> coa~.A-~c~e: 5s$-79o4 SITE #; <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete_all Sections, I through 5 <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />P EKM1T~ ARB NON-TRANSFERABLE AND NON.REFUNDABLE AND <br />EXI~RE l~? WORK IS NOT STARTED W1THI/~ 180 DAYS OF I$SUANCB <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />No. 2 5 3 5 9 <br /> <br />Sigoatum of Supe~vlalng ~r~ciatl <br /> <br /> FOR OWNER INI~ALLATION$ <br />l~[~rty Owucr <br /> <br />Mailing Address <br />City/State]Zip <br /> <br />Tho ~nst~la~[o~ is I~'..,ias made on propt:ny I owe which is ~o~ ia~nd~l for <br /> <br />Owner{ Signamm _ <br /> <br /> PLAN REVIEW SECTION <br /> <br /> Wc will provide plan review ~ervice if you complete Section <br /> 5B and submil two (2) sets of plans and specdicafions 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 Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC .15-34 11/91 <br /> <br />Permit No. <br /> <br />Date: <br /> <br /> Issued by: <br /> <br />4, FEE SCHEDULE (Complete and en~r to*al ia A1 below) <br /> Nl~mber of Insp~tlons permit allowed <br /> p~ <br /> <br /> Semite Included: X,,. It~z C~t (ea~) Sum <br /> <br />E~ ad&6o~ 5~ sq, fi, <br />~ffi~ ~tcof ~ $15,00 ,~ <br />L~d E~y ~ $20,00 <br />Ea~ M~ufd flom~ or M~ular <br />~ ~c~ or Fe~er ~ $40,00 <br /> <br />~1 amps ~ 1~0 amps ~ $130,~ ~ <br />~. Temporar7 <br />401 ~ps to ~0 ~ps ~ $80,00 <br /> <br /> a) ~ f~ f~ bmn*h ~r¢~ts ~ <br /> <br /> b) ~ fm for ~anah ~rmts ~ <br /> <br /> F~t branch circuit ~ $35,00 <br /> <br />E. M/~ella~u/($ervl~ Or Fe~er Not <br /> ~h ~mp ~ i~gafi~ ~rde , $40.00 <br /> ~ si~ or ou~e ~g , $~,00 <br /> <br /> ~er ~ ~owab~ ~ my of ~ <br /> a~, per ~sp~fion $35.00 <br /> <br /> (~d ody lo ~le~lric;l ao~ra~tor~) <br /> <br /> (As ~q~rad by Bui~ing O~a~l) <br /> <br /> A2. Add 5% su~ha~e (.05 x Al) $ ~ <br /> <br /> (S~, 3), if ~r~ $ ~ <br /> C. Investigation F~ (ff mqui~) $ <br /> D. Re~s~fi~ F~ ($~,~) $ <br /> <br /> mTALAMO~T DUE $ <br /> ~ecelgt No, - <br /> <br /> <br />