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yea. qmcs uss ON Y <br />f{ece~ved by: <br />Date: ' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> Phon~ 588-5147 S:O0 ~l~ - 4:30pm <br /> Code-A-Pno-~: <br /> FAX: 585-7945 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />,it <br /> <br />Di~o~s <br /> <br />PI~I, tM3.T S ~M't.E NON-TIL~NS. FERAI~LB AND NON -REFLVN13ABLE AND <br />EX~IRE IF WORK IS NOT STARTED W1TII1N 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />PARK I Ix} El..ECTFc 1£ (l:~ I NC. <br />20250 S MC}L_AL_LA AV]iiilixlLJEi[ <br />DREGON f,3',[TV~ OR '37045 <br />2 4 ~5"'" 1301 <br /> <br />BOARD t,,I =,, ,N: 35151 <br /> <br />FOR OWNER INSTALLKrlONS <br /> <br />Mai,lNg Address ,, Phone <br />CitylStat¢[~p <br /> <br />T~¢ installation is b~ing mad~ on proFerty t own which ia not inmnded for sale. <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review scow/ce if you complete Section <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 />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />SITE #: ....... r~ ~^,. ~ <br /> <br />Date: <br /> ~ARION COUNTY <br />Issue~g',Ng hNaPECTiON <br /> <br />4. FEE SCHEDULE (Complete and ent~t teal in A 1 below) <br /> <br /> Number of Inspections p~r permit allow~ <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> ,. <br /> / <br /> Service Inclmle~l: Items Cos* (each) Sum <br /> <br /> $85,00 <br /> 1000 sq. ~ or <br /> Each afldltic~al 500 aq. ~. <br /> or portion thereof $ ~ 5,00 <br /> Limil~d Energy $90.00 --.~ ~ <br /> <br />R. Serrlo~ or Fe,~ler~ (Does not inlcude bran0h circuits, see ~ectlon D) <br /> <br /> <br />