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Received by: <br />Date! ' i <br /> <br /> COUHT¥ BUILDinG INSPECTIO~ECE[VE~ <br />MARION <br /> 220 High S~t ~ <br /> Salem, O~gon 97301 <br /> <br /> Ph~ 588-5147 8:~ ~m - 4:3~m <br /> F~: ~8~-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />Please complete ali Sections, I through 5 <br /> I <br /> <br />pI~.M1TS ARE NON-TRANSFERABLE AND NON.I~FU'N'DABLE AND <br />Fe3~PI~E ~ WORK IS NOT STARTS) ~ 180 DAYS OF I$S~UANCE <br />OR ~ WORKIS SUSPI~N~ED FOP, 1~0 DAYS+ <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's Board Reg, No, <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Mailing Address 1 Phone <br /> <br />Owners Signatum., <br /> <br />3. PLAN REVIEW SF~T£ION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B and submit two (2) S~ts of plans and specifications with <br /> t~is application. <br /> <br /> This optional plan review program does not suspend tho <br /> gqukeA submission of I~ghting power calculations, plans, <br /> and specifications when re~uh-ed by the Oregon Structural <br /> Specialty Codo, Chapter 53. <br /> I Illlllll Ill I II <br />MC 15434 I//gl <br /> <br /> Fr3 24 <br />SITE #:MAn!0~ ~_m3~ ~e. trait N°- <br />'Date:BUILDING iNSPECTION <br /> <br />R~i , No <br /> <br /> ~50,00 2 <br /> 60.00 2 <br />$100,00 2 <br />$130.00 .. ~ <br />$~00,00 ~ 2 <br />$4O,00 2 <br /> <br />~35,00 <br /> 40.00 <br />$80.00 <br /> <br />$40,00 <br />$40,00 <br /> <br />$40,00 ~2 <br /> <br />$ <br />$ <br />.$ <br /> <br />4. FEE SCII[,DULE (Complete and enter total ia Al below) <br /> <br /> Number Of Inspections per permit ~llowed <br /> / <br /> &, Residential Per Unit <br /> <br />t000 sq. ft. ct less $85.00 <br />Each afl&fional 5~0 sq. It. <br />or gord~ ~emof $15,00 <br />[,,~'~ l~ta'y ' $20.00 1 <br />Each MaaufdHom~ o~ Modular <br />Dwel.l~g Ser~dc~ or F~ $40.00 _ <br /> <br />~, Se~l~ or F~ders ~s aOt ~laude branch ~uJ[s, s~ s~ D) <br /> In~maflon, AIt~atlons w Rd~tian <br /> ~ ~ ~ le~ <br /> <br /> ~1 ~ m ~ ~p~ <br /> ~1 am~ ~ l~ am~ <br /> ~r 1~ ~ps or vol~ <br /> <br /> C. Tem~r~ ~ ~ps or le~s <br /> <br /> 401 ~pa to ~ am~ <br /> <br /> pu~h~¢,of se~ ~ f~r <br /> <br /> ~ch b~ch ~ult $2.~ <br /> <br /> b) ~ f~ f~ branch ~s <br /> ~ha~e qf,~e~ce or feeder fe~ <br /> <br /> F~t branch elreu~t ~ $~,00 <br /> ~ach ~flifi~ ~eh ~uit ~ $2.~ ., <br /> <br /> $~B~ c~euit(s) Or a ~ted enemy <br /> a~. ~t ~c~on $~5.00 <br /> <br /> ~. FEES <br /> Al, ~ter t~al of fees from Sa~ g4 $ $. <br /> A2. Add 3% sa~ha~ (.05 x Al) <br /> <br /> $ <br /> <br /> D. Re~s~ F~ ~.~) <br /> <br /> ~TAL ~O~ DUE <br /> <br /> <br />