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MARION COUNTY BUILDING II~_. E~T~[O ~1~ <br /> 220 High Street NE ,~,~ <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:130 am- 4:30Fen <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />FOR O~FiCE USE ONLY <br />R~ceived by: <br />Date; <br /> <br /> Permit No, <br /> <br />Oate,~ ~' !M,r,L~ 7r"Tz~M <br /> <br />issued by: <br /> <br />Dimcfi .ms <br /> <br />lffff~VllT$ ARE NON-TRANSFERABLE AND NON-REiqJNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OK LF WORK IS SUSPENDED FOg. 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />Signature of Supervising El~trle, ian <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Ma~ng Addi~as Phone <br />City/Sta~/Zip <br /> <br />PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you comp!ere Section <br /> 5B and submtt two (2) sets of plans and spectficauons,w~th <br /> this application. <br /> <br />This optional plan review program does not suspend the. <br />required submission of lighting power c',dculations, plans, <br />and specifications when required by the Oregon Structural <br />Speciahy Code, Chapter 53, <br /> <br />$, FEE SCHEDULE (~omplele and enter total in Rl below) <br /> <br /> Number of InspeeEons p~ permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> una <br /> Service Included: It,s Cost (each) Sum <br /> <br /> 10~ sq. fi. ~ le~s .... $85.00 <br /> E~h ad~al ~ sq. <br /> <br /> ~h Manned Ho~ or M~u~r <br /> Dw¢~ng 8e~m ~ Feed~ $40.00 <br /> <br />B. $er~ or Fedders (Dogs not ~i~de branch ci ~oila. $~ aeetinn <br /> <br /> Over 600 amps or I000 volts <br /> <br />D. Branch Circuits <br /> <br /> a) Th~ fe~ for brach circui~ wlth <br /> <br /> b) The f~ for branch c[~OtS 3~ilhout <br /> <br /> Each additional branch cfirctfit ~ <br /> <br /> Pack of 10 Iai:~ls @ $5.00 each <br /> <br /> 50.00 <br /> ~60.00 <br />$~00.00 __ 2 <br />$130.00 __2 <br />$300,00 <br /> $40,00 __ 2 <br /> <br />$85.00 <br />$40.00 ~2 <br />GBO.O0 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2,oo <br /> <br />$40.00 2 <br />$40,0O 2 <br /> <br />$40,00 --2 <br /> <br />$35,0O ~ <br /> <br />$50,00 <br /> <br />5. FEES <br /> At, Er~tc~ [mai of f~es from Sue. #4 , <br /> A2. Add 5% surcharge 605 x Al) <br /> <br /> Subtotal <br /> <br /> Fl. t~nter 25% o£ llne A 1 for Plan Review <br /> (Sec. 3), if requlred <br /> C. Investigation Fee (if required) <br /> D, Rclnspecfion Fee ($2,5,00) <br /> <br /> TOTAL AMOUNT D t.J L; <br /> <br /> Receipt No. <br /> <br />$ <br />$ <br />$ <br /> <br />MC 13-3411f91 , <br /> <br /> <br />