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FOI~ OFFICE USE ONLY <br />Received by: <br />Dale: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Streel NE <br /> Salem. Oregon 97301 <br /> <br /> Phone 588-5147 $:UO am . 4:30pm <br /> F/tX: 588-7948 SITE #: __ <br /> <br />ELECTRICALPERMITAPPLICATION I <br />Please complete 811 Sections, I through 5 <br /> <br />I. LOCATION OFINS~TALLA'I'ION <br /> <br />~o~dd~s~ 8474 W. Stayton Rd. <br />City Aumsville ] <br /> <br />Directions <br /> <br />Security System <br /> <br />PERMTI'S ARE NON-TRANSFERABLE AND NON-R.EFUNDABLE ANT) <br />EXP/RE IF WORX tS NOT STARTED WyFIII N 180 DAY:::; OF ISSUANCE <br />OR [F WORK i$ SUSPI6\'DED FOR ! $0 DAYS. <br /> <br />2A. CONTRAC~I'OR INSTALLATION ONLY <br />El¢c:dcalC~a,actor Alltec Security [~,o,e 503/331-26'. <br />~.~i~^od~,,PO BOX 55310 - Portland, OR 97238-531 <br /> <br />momny o~,.~r John & Melida Hixson 11'~"~503/749-402! <br />co.,,c~oc, l-ic~e ~o. '26-307~E <br /> <br />Supemisofs IJ~nse No. 2573~E ' } Phon~ No. S~e <br /> <br />2B. FOR OWNER INSTAI.LATION$ <br /> <br />Property Owner <br />Mail,S Ad~tc--sS ['hotxC <br />City/State[Z: p <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We wiU provide plan review se~ice if you complete Section <br />58 and submit two (2) sets of plans and specifications with <br />thi~ 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-$4 11/9l <br /> <br /> Issued by: <br /> <br />4. FEE SCIIEDLILE (Completed cruet total in A I below) <br /> <br />$85.00 <br /> <br />$~500 <br /> <br />A. Residential Per Unit <br />Service [nrluded: <br /> <br /> b) Thc Io: for branch cqrcuts 'e.'i:]~OU~ <br /> <br /> a~vc. per trisection $~.~ <br /> <br />5. FEES <br /> Al. Enter Iola] Of fCCS from Sec. #4 <br /> A2. Add 5% surcha~c (05 x Al) <br /> <br /> (Sec. 3), if requited <br /> C. l~ves6gationFe~ {if ¢cq~C~cd) <br /> D. Re~s~ Fee ~25.~) <br /> <br /> 'IOTAL AMOU~ DUE <br /> <br />$ 20.00 <br />S I II[_l <br />$21.00 <br /> <br />$ 21.00 <br /> <br />Itccclj~ No . <br /> <br /> <br />