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I'"'FOR oFFIcE ~'~E oNLy <br />Rec~ved b~ <br /> Date: <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-51478:00 ~ra - 4:30pm <br /> Cod*-A-Phon~; 588-7904 <br /> FAX: 588-7948 SITE #: <br /> <br /> Date: <br /> <br />Issued by: <br /> <br />1, LOCATION OFINSTALLATION <br />Job Address <br /> <br />Directions <br /> <br />Cross St. <br /> <br />PERMITS ARE NON.TRANSFeRABLE AND NON-R~FUNDABLI~ AND <br />EXPB~.E IF WORlC. I$ NOT STARTED Wll~qlN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPBNDED FOR 180 DAYS- <br /> <br /> cONTRACTOR INSTALLATION ONLY <br /> <br />EleczricalCr~ltr~ZER ELECTRIC INF. hone 378-0267 <br />MailiasAddress 1410 ~D~SON ST. <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Prol:~tty Owner <br /> <br />Mailing Address Phone <br /> <br />Chy/Stat~/Zip <br /> <br />'i'h~ imtallatlon is b~ing made o~ property I own which is not Jnmnded for sale, <br /> <br />Owner's Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan review setwice if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />tiffs application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Speci~hy Code, Chapmr 53. <br /> <br />MC 15-34 11/91 <br /> <br />4. FEE SCHEDULE (Complete and ealt~r ;oral <br /> <br /> Number of lnspeC <br /> <br />A. Re~id~ntlal Per Unit <br />Service Included: It~ans <br /> <br />1~ sq, ft. ~ less <br />~ach a8~6o~15~ sq. ~, <br />L~i~n~y <br /> Dw~g $*~ or Fc~ <br /> <br />B. Ser~c~ or Feeders ~oes not ~lcude <br /> <br /> ~1 ~pa to ~ amps <br /> <br /> ~er I~0 ~ps or vol~ <br /> Rennet ~y <br /> <br /> C, T~mporary <br /> <br /> 2~ raps or less <br /> 201 ~ps to ~0 a~ps <br /> ~I~psto~mtpss <br /> <br /> pure,ha ~e of ~e~ ~ fc~cr <br /> <br /> ~ch brach cimuit <br /> <br /> b) ~e f~ for branch ~rcut~ wi~out <br /> <br /> First b~nch ~rc~l <br /> <br /> E. Miscellanies (Service Or Feeder Not Inc <br /> ~ach pump or i~gs~ circl~ <br /> ~ch sign or m~e ~gh~g <br /> ~nal ckcuit(*) or a ~d <br /> <br /> ~. Each additional Insp~tiOn <br /> ~cr ~e ~owable ~ any of ~ <br /> a~w. p~r <br /> <br /> Pack of 10 lulls ~ ~,~ ea~ ....... <br /> <br /> ( A~ r~q~red by Building Off&hi) <br /> <br /> 5. ~EES <br /> Al. Enmr real of fees from 5cc. <br /> A2. Add 5% *urcha~e (,05 x Al) <br /> <br /> Subto~ <br /> <br /> B. Enur 2~% of line A I for Plan R~view <br /> <br /> C- lnwstigafionFeg (ff mqukcd) <br /> D. Rc~specfim F~g ($~,00) <br /> <br /> TOTAL AMOU~ DUB <br /> Recei?t No. , ........... <br /> <br /> b~low) <br /> <br />per permit allowed <br /> <br />Cost each) Sum <br />$85,00 <br /> <br /> $15.00 <br /> $20.00 <br /> <br /> $40.00 __2 <br /> <br /> ~50.00 <br /> 60.00 --2 <br /> $100,00 __ 2 <br /> $130.00 <br /> $300.00 2 <br /> $40.00 <br /> <br />$35.00 <br />SdO.O0 <br />$80,00 <br /> <br />$2,00 <br /> <br />$35,00 <br /> $2.00 <br /> <br />t) <br /> $40,00 <br /> $40,00 <br /> <br />$40,00 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br />$ <br /> <br />P :No, <br /> <br /> <br />