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FOR OFEICE USE ONLY <br />Recei. yed by: <br />Date: ,, <br /> <br />MARION COUNTY BUILDING INSPECTION ... <br /> <br /> phon~ 585-$147 s:O0 ~ - 4:30pm <br /> Cod~-A-Pho'o~: $85-79~ PeTmit No, <br /> FAX: 5SS-?~S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION" <br />Please complete all Sections, 1 through <br /> <br />L LOCATION OF INSTALLATION <br />fobAddms~ <br /> <br />D~scripfim~ <br /> <br />PERMI'i~S ARB NON.TRANSFERA BLE AND NON-RE FUNDAB LE AND <br />EXI~E IF WORK IS NOT STARTED ~ lS0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR lg0 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER iNSTALLaTiONS <br /> <br />PmI~y Owner <br /> <br />Mailing Address <br /> <br />Ci/y~Statef~p <br /> <br />The installation ia b~ing made on property I own which is nm in~ndeA fo~ sal~, <br /> <br />O,,va~r's Sig~'mr~ ..... <br /> <br />3. PLAN RE¥1EW SECTION <br /> <br /> W~ will provide plan review $~rvice if you complete Section <br /> 5B and submit two (2) seti 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 cfilcalafions, plans, <br />aml specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53, <br /> <br />MC 15-341]/91 <br /> <br />FEE gt2HED~ <br /> <br />A, Residential Per <br /> Se~ce inc~de& <br /> $85.00 <br /> ~ ~ ~ $15,00 <br /> D~S S~ ~ Feed~ ~ 540.00 <br /> <br /> ~er 1~ <br /> <br /> 2~ ~p~ or <br /> 201 ~ps to <br /> 401 ~pa to <br /> <br /> pure~$e.~ sc~ ~ fe~cr fee <br /> <br /> Bach bm~h c~it <br /> <br /> b) ~ f~ forth <br /> <br /> F~t ~ ci~ $35.00 <br /> ~ Mdifi~al <br /> <br /> ~ ~mp or ~gafi~ ~le ~ $~0.00 <br /> ~ch ~i~ or ~c ~h~g ~ $40.00 <br /> Sig~ ~t(1) ~ a ~ cne~y <br /> ~M, d~mi~ or ~tm~ $40.~ <br /> <br /> a~e. ~ ~ecfion $~5.00 <br /> Pa~ ~ t0 [a~h ~ $5.~ ~ch $50.00 <br /> <br /> ( A~ ~q~r~d ~ BaiMi~ Offical) <br /> <br />-'g._ FEES " ' <br /> <br /> Al. Enter total of fees from See. #4 $ <br /> A2. Add 5% mmha~e (,05 x Al) $ <br /> <br /> Submtal $ <br /> B, Enter ~% ~ ~e A1 for Hah Review <br /> C. ~vcstigafi~ Fee (ff~uimd) $. <br /> <br /> 7D'FAL AMOU~ DUE <br /> <br />Receip~ No, <br /> <br /> <br />