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" ' MARION COUNTY FOR OFFICE USE ONLY . 2~0 Hi Date:~ ................. 1. LOCATION OFIN,~PALLATION Div:~dons P .-ERMrrS ARE NON-'IRANSI~R ABLE AND NON.REFUNDABLE AND ~XPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS, 2A, CONTRACTOR INSTALLATION ONLY Elecndcal Cotlt~tl~tlm Electrical Con~t..t. Mailing Address Salem, Oregon 97"304 ,,~-'~.4191 Signature Of Su~isag ~tdclan ~ _ ~ . 2B. FOR OWNER 1NSTALLKFIONS Ma~ng Address } Phone Ci~y/~tatcf~ip 3. PLAN REVIEW SECTION Wc will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this applicatiom This optional plan review program does not suspend the required submission of lighting power calculations, plans, and specifications when required by the O~regon Structural Specialty Code, Chapter 53. 4, FEE SCHEDULE (Complete and enter total in A 1 below) Number og lnsp~c6ons p~r p~rmit allowed A. R~iden~al P~r Unit $e~J~ Included: It,s Cost (e~) Sum/ ~ $85.00 4 1~ sq. fi. ~ tess ~h ad~l 5(~ sq, ft, or ~ ~e~of ...... $15.00 g~h ~d Hem* or M~uhr Dw~ Sc~ or F~edcr $40.00 2 lns~llat~, Al~att~s ~ Rd~ati~m ~ ~ps ~ less ~ $50.00 2 ~[ ~m~ m 4~ aatpa $60.00 ~1 am~ m 1~0 amps $130.~ ~ 2 R~ect ~ly $40.00 ~ C. 3~mgor~y Servicings 2~ ~ps or less $35.00 2 401 ~ps to ~ am~ ~ $~.00 Owr ~0 a~ or 1~ vola D, Branch Circui~ b) ~ f~ f~ br~ ~ts M~out ~ ~mp or ~gafim ~e $40,~ 2 ~ s~ or ~ l~g ..... $40,00 2 ~ck of I0 la~s ~ $5.~ ea~ $50.00 ( A~ r~q~md by B~iMing Off&~0 5. 'FEES A2. Add 5% surcha~e (.05 x Al) Suni (S~. 3). if rm~r~ $ C, ~vaqt~afion Fee (ff required) D. Re~s~m F~ ($~.00) MC 15.34 H/91 No.