Laserfiche WebLink
FOR OFFICE USE ONLY <br /> Rece/ved by: <br />I Date: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High $1~eet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 ~n - 4:30pm <br /> Co~-A-Phoxm: 5gg-7904 <br /> FAX: 588-7948 SiTE #: <br />ELECTRICAL PERMIT APPLICATION ] Date: <br />Please complete all Sections, 1 through 5] Issued by; <br /> <br />Permit Nc,, <br /> <br />1, LOCATION OFINSTALLATION <br />,lob Addi~ss 8"t~ ~ i,~ ' ~ <br /> <br />LpERMITS ARE NON-TRANSFERABLE AND NON-RB~NDABLE AND <br /> ItXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br /> OR IF WORK IS SUSPENDED FOR 1 SO DAYS, <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prol:~rt~ Ownar <br /> <br />Mailing Addross <br /> <br />City/~tat¢~[@ <br /> <br />The imtaEation is being made on property I own which is not in~ndcd for sale, <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan review se~ic¢; if you coalplete Segtion <br />5B 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 /> roq, uired submission of lighting power calculations, plans, <br /> an(l specfficatioos when required by the Oregon Structural <br /> Specialty Code, Chapter <br /> <br />MC 15-34 ]1/91 <br /> <br />FEE SCHEDULE (Complete and ¢n~r total in A I below) <br /> <br /> Number of tnsp~thins p~' permit allowed <br /> <br />A. <br /> Per <br /> Semite Inehid~: ~s Cost (¢~h) Sum/ <br /> <br /> 1~ sq. ~ ~lcss $85,~ ~ <br /> E~h ad~6~ 5~ sq, f~, <br /> ~ ~ ~cmof $15,00 <br /> ~i~d ~ $~.00 <br /> E~h M~ufd I,I~ or <br /> <br />~. $er~ or Fee~rs ~s not ~lcad~ branch cim~, see $eclion D) <br /> <br /> ~ ~ or t~s$ $50.00 <br /> ~1 ~ to 4~ps $60,00 <br /> <br /> ~I ~ ~ 1~ $130,~ <br /> Re~ct ~ $40,00 <br /> <br />C. Tem~rary <br />Ins~lagon, Alteration, or Rd~aflon <br />2~ ~p$ or less $35.00 <br />~1 ~ to ~ am~ $40.00 <br />401 ~ps ~ ~0 ~ps $80.00 ~ <br />~e~ ~ ~pa or 1~ volts <br /> <br />D. Branch Circul~ <br /> <br /> ~ha~c of sc~ or fc~er f~ <br /> F~t b~nch c~it Saa,0o <br /> <br /> E. Ml~llan~us {$ervl~ or F~r Not <br /> ~ch ~p ~ i~gad~ c~e $40,00 <br /> Each a~ or once ~h~g ~ $40,00 ~ <br /> Signal ~it($) ~ a ~md enc~y <br /> ~d, Mm~fi~ ~ ~si~ $40.00 <br /> <br />Y. ~ach additional <br />~, ~r laspec~ $85.00 <br />G. Minor Ins~llation ~els <br />($oM o~y ~0 ¢leatri~l comractor$) <br /> <br />H. Other <br /> ( As req~r~d by Building Off~0 <br /> <br /> s. V gs <br /> <br /> 1. ~r t~al of fees from S~c, $4 $ <br /> A <br /> A2. Add 5% surchage (.05 x Al) <br /> <br /> B. En~r ~% of ~n~ Al for Plau Review <br /> (S~, 3), d mqu~r~ $ <br /> C. Inv~s~af~F~ (~ mquir~) $ <br /> D, Re~s~fim Fee ($~.~) $ <br /> TOTAL AMOU~ DUE $ ~ ~ <br /> <br />Receipt No, , , <br /> <br /> <br />