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FOR OFFICE USE ONLY <br />R eceiv, pd by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 I-Iigh Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phon~ 588.5147 8:00 =n - 4:30pm <br /> Code-A-Phone; 588-7904 <br /> FAX: 588-7948 $1T¢: #: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> P/ease complete all Sections, I through 5 <br /> <br /> 1, LOCATION OFINbq'ALLATION <br /> <br /> JobAddms~ 140 S, 7th St, <br /> <br /> Cie Aumsville { Cros~St- <br /> W. <br /> Stayton <br /> Rd <br /> <br /> Di~ti~,s Turn S. at BP station (1) block <br />on left old JaF Feed a Seed Bldg. <br /> <br /> Wiring bathroom <br /> <br /> P~R~ AR~ NON.~S~RABL~ ~ NON-~AB~ <br /> ~XP~ ~' WO~ IS NOT STARTED ~ I~0 DAYS O~ <br /> OR ~ WORK IS SUSP~DED FOR 180 DAYS, <br /> <br /> gA. CONTRA(TFOR [N~ALLATION ONlY <br /> Ele~dcalCmxtmcmt Code Electric [Phme 581 -8684 <br /> ~a~gAddr*~* 2717 22nd St. SE - Salem <br /> American Easel ~°n'585-4324 <br /> <br /> Contramof~ Board Rug, No, 1 9 8 6 6 {Yob No, <br /> <br />Issued by: <br /> <br />Permit <br /> <br />-8684 <br /> <br />2B. FOR O~ER INS'rALLATIONS <br />Property Owner <br />Mailing Address , Phone <br />City~[at¢£iip <br /> <br />3. Pr,AN REVIEW SE~, FION <br /> <br />We will provid¢ plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />[his 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 />4. FEE SCHEDULE (Cumplete and enter total in A1 b,low/ <br /> <br /> Number of InspeCtions per permit allo~ed ~ <br /> <br />A, <br /> R~ldentlal <br /> Pot <br /> Se~ice Included: Items Cost (each) Sum <br /> 1~ sq, f~ or le~s $85.00 ~ 4 <br /> Each ad~o~al 5~ sq, fL <br /> or ~ themoi $15,00 <br /> ~i~ Enemy $20.00 ~ 1 <br /> Each Manufd Home or M~ulaf <br /> Dwe~g Sc~ or Feeder $40.00 ~ 2 <br /> <br />B. Services or Feeders,(DO¢S nO[ inlcud¢ branch cwcukL s~o section D) <br /> <br />200 amps of I~ss <br />201 amp~ m 400 ~nps ~ <br />401 aml~ to 600 amps ...... <br />601 amps to 1D00 amps <br /> <br /> Pack of 10 la~ls @ $5.00 each <br /> <br />~50.00 <br />60,00 ~ ~ <br />$100.00 _.__ ~ <br />$130,00 <br />$300,0o __ 2 <br /> $4o.oo __ 2 <br /> <br />$85.00 <br />$40.00 <br />$80,00 <br /> <br />$2_.00 <br /> <br />$~5oo <br /> $200 <br /> <br />$4000 <br />$4000 <br /> <br />$40.00 .... 2 <br /> <br />$3500 <br /> <br />$50.00 <br /> <br /> FEES <br /> <br />A2. Add 5% Surcharge (.05 x A 1) <br /> <br /> (Sec. 3), if mquir~ <br />C, investlgat{onFue (if mquh'¢d) <br />D. Reinspecdon Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUF <br /> <br />Receipt No. <br /> <br />$,45.00 <br /> 2 .-~5 <br /> 47,25 <br /> <br />S__ <br /> <br />MC 15-34 11/91 .... <br /> <br /> <br />