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IFOR OFFICE USE ONLY <br />R~ceived <br />Date: <br /> pt~orm 588-~I47 8:(10 ara - 4:30pta <br /> Code. A-PEons: 588-7904 <br /> FAX: 58g-79dS <br /> ELECTRICAL PERMIT APPLICATION ] <br /> Please complete al~ Sections, I through 5 <br /> <br />MARION COUI~TY B~JILDING INSPECTION <br /> <br /> Salem, Oregon 97301 <br /> SITE#: ~'¥ ~ 9 t99~-Perm)tNo' <br /> Date: MARION COUNI¥ <br /> BUILDING INSPECTION <br /> Issued by: <br /> <br />Directions <br />D~sc~.pfion LV ~ <br /> <br />PF]~MITS ARE NON,%~ANSFERABLE AND NON -KEFUNDABLE AND <br />EXP/RE IE WORK` IS NOT STARTED WI'IlliN 180 DAYS OF ISSUANCE <br />OP. IF WORK IS SUSPENDF. I) FOR I80 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Elec~ricalContraetor BRINKS t-ICI'4E SEC, {Phone641-0574 <br /> <br />MaillngAddr¢~a 8059 SW CIRRUS DR. <br />Prolx:rty <br /> Owner <br /> I 678-5295 <br />c~r. ctor's License No, 34-166 ~ <br /> <br />con,~a¢,or'~ Board Reg. No, 44421 I Job No. 618956 <br />Sigllalure of Supervising Electrician ~, ~ <br /> <br />Supe,vi~or% t.icense No. 592 ,TLE <br /> <br />IPhone No, 641-0574 <br /> <br />2il. leer OWNER INSTALi.ATIONS <br /> <br />Mailing Address Phone <br />Chy/S~alefZip <br /> <br />The lilstaliation is being made on property I own wJfich is not ~tendcd for sale, <br /> <br />Ownm"~ Signature ...... <br /> <br />3, lq.AN REVIEW SECTION <br /> <br />We will provide plan review service if yOu complete Section <br />58 and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />reituircd submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Speciahy Cede, Chapter 53, <br /> <br />$- FEE SCHEDULf2 (Complete mad enter :olal in A I below) <br /> <br /> Number of Inspections per permil allowed ~ <br /> <br />A. <br /> Rt~idential <br /> UnR <br /> I <br /> Se~ice Inclvded: Items Co~t (each) Sum/ <br /> <br /> 10~ sq. E. m leas $88.00 ~ 4 <br /> Each ad~fi~l 5~ sq, fl. <br /> or ~ffim thereof $1 $,00 <br /> Limi~ Enemy , 1 $20.00 <br /> <br />Each Manofd Ilome or Mextolar <br />Dwelling $¢rv/~c or Feeder $40.00 <br /> <br /> 201 aml~ to 400 strips <br /> <br /> {501 amps to 1 frO() ampe <br /> <br />C, T~po~ry <br /> <br /> 401 ~pa to ~0 amps <br /> Owr 6~ amps or I0~ volts <br /> <br /> b) 2he f~ for bcaaeh ~rcuts whh~ <br /> <br /> ~ ~mp or i~igafim clrcle <br /> <br /> Signal ~rcuit(s) or a h~t~d enemy <br /> <br />G. Minor Installation Labels <br /> Pack ~ [0 la~l~ ~ ~,~ each <br /> (~-old only to electrical contractors) <br /> <br /> (As mquired by Buil~in$ Offic~ <br /> <br />· 50.00 <br />60.00 ~., 8 <br />$100.00 2 <br />$130.00 2 <br />$300.00 ..... 2 <br />$40.00 __ 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 __2 <br /> <br />$2.00 <br /> <br />$38.00 <br /> $2.00 __ <br /> <br />$40.00 -- 2 <br />$40.00 --, 2 <br /> <br />$40.00 ~ 2 <br /> <br />$35.00 <br /> <br />$~.oo <br /> <br />5. FEES <br /> Al, Enter total of fees from Sec. #4 <br /> A2. Add 5% Surcharge (,05 x At) <br /> <br /> Sublotal <br /> <br /> B, Enter 25% of line A1 t~>r Plan Review <br /> (Sec. 3), if mq~rod <br /> C. InvcstjgationFce (if required) <br /> D. ReLn~p~fim Fee ($25.00) <br /> <br /> TOTAL AMOUNT DU~'~ <br /> <br />20.00 <br /> <br /> 21,00 <br />$ <br /> <br />MC 1.5-34 ]1/9l .,, Receipt No. <br /> <br /> <br />