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I <br />Received by:. <br /> I <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete ali Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 5g$-5147 g:O0 mn - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 SiTE #: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />Permit No, <br /> <br />PF, RMITS ARE NON-TR.ANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE LW WORK IS NOT STARTED W1TI tlN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SU$?END~D FOR 1 S0 DAYS. <br /> <br />2B- FOR OWNER INBTALLATION$ <br /> <br />PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B and submit two (2) sets o£ plans and specifications wkh <br /> this application, <br /> <br />This optional plan review program does not suspend the <br />required submission Of lighting power calculations, plans, <br />and specificmions when required by the Oregon Structural <br />Specialty Code, Chapter 53, <br /> <br />MC 15.34 ll/9l <br /> <br />4l FEE SCHEDULE (Complete md enter total Jn A 1 below) <br /> <br /> Number of Inspe~[ton~ per petrol! allowed <br /> <br />A, <br /> Resid*ntlat <br /> Unit <br /> <br />a) The fee for branch drcaits ~ <br /> P~'q"9'a ' e °f ~ ervlce 9r feed elf ~'ce J~ <br />h) The f~ for branch cJrcats ~out <br />~hase of scmiq¢ or fe~der fe~ <br /> <br /> Ea~ ~did~a[ branch cimuit <br /> <br /> Each siam or o~n~ l~fing <br /> <br /> (As ~quir~d by B~ildlng Officio <br /> <br />~50.00 ~' ~ 2 <br />$100.00 2 <br />$130.00 ~II 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 />$35.00 <br /> $2,oo <br /> <br />$40.00 <br />$40,00 <br /> <br />$40.00 <br /> <br />$35.00 ., <br /> <br />5. FEES <br /> <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> r~. Enmr 2~% of l.in~ Al tbr Plan R=vlew <br /> (,Sec, ~), if tcqui~¢d <br /> C, InvesfigationFce (il* required) <br /> D, Reinspccdon Fee ($Z~;.00) <br /> <br /> 'IX)TAI, AMOUNT DUE <br /> <br /> Receipt No, <br /> <br />$__ <br /> <br /> <br />