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['FOR OF_FI. CE USE ONLY [ MARION COUNTY BUILDING INSPECTION <br /> Salem, O~gon 97301 <br />l Date: ....y,~ '-/~r_ ~?yr Phone 588-5147 8:00 mn-4:S0pm <br /> Code-A-Phone: 5S$-7904 SITE #0~ <br /> FAX: 588-7948 <br />I ELECTRICAL PERMIT APPLICATION I Date: <br /> Please complete all Sections, I through 5 <br /> $$ueoDy .... <br /> <br />PERMFI'S AR5 NON.]T~ANSF£RAI~LE AND NON-REFUNDAB LE AND <br />EXPIRE IF WORK IS NOT STARTED WITI-Ii~q 180 DAYS OF ISSUANC~ <br />OR IF WORK IS SUSPIiNDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Eleafical Contractor phone <br /> <br />M~dl~ng Address <br /> <br />Pmpcny Owner <br /> <br />Contractor's Lic~se No, <br /> <br />Contractor's goard Reg. No, <br /> <br />$ignamm c~ Supervising Elcctdclan <br /> <br />,]Phone <br /> <br />! ,,,,, Sup~rvimr's Liccm¢ No. I l~om: No, <br /> 2~, FOR OWNER INSTALLATIONS <br /> <br />$. PLAN REVIEW SIeJ. TrlON <br /> <br /> We will provide plan review service if you complete Section <br /> 51] and submit two (2) sets of plans and specificat/ons with <br /> this application. <br /> <br />This optional plan review prognun docs not sus~nd the <br />required submission of lighting power calculations, plans, <br />and specifications when required by thc Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />4, FEE SCHEDULE (Complete and egret to al m A1 below) <br /> <br /> Residential <br /> Per <br /> SerVice Included: Items Cost (each) <br /> <br /> 200 amps or less <br /> <br />R~corme~t cmly $40.00 <br />C. Tem~rary Servitudes <br />~ amps or less <br /> <br /> ~*r ~ ~ps or 1~ volts <br /> <br /> ~h brach c~ult ~ $2,00 <br /> b) ~ f~ f~ ~ch drcuts ~ <br /> <br /> First branch circuit ., <br /> E~ch dgn ~r o~ ~ht~g ~ $~0,00 <br /> <br /> ( A~ ~q~rad ~ Bailding Off&&l) <br /> 5. FEES' <br /> Al. Enmr meal of fees fr~ Bec, ~4 $ <br /> A2, Add 5% samha~* (,0J x Al) $ <br /> <br /> s~b~o~ <br /> 'rOTAL AMOU~ DUE $ <br /> <br /> <br />