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---4-vo t CXT VA D^ ON I <br /> <br />MARION COUNTY BUILDING zNSPBCTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NI~ · Room 132 <br /> Salem, OR 97301 <br /> <br /> PERMIT NO: <br /> <br /> Date: <br /> <br />Office: <br /> <br /> ~ch addifio~l 5~ sq. ~. <br /> <br /> ~ Manufaem~ H~g or Mo~l~ <br /> <br /> 2~ amps or 1~ $~ 2 <br /> ~1 am~ to ~ ~ $1~ 2 <br /> <br /> ~er 1~ ~ps or vol~ $3ffi.~ 2 <br /> Remnn~t only ~.~ 2 <br /> <br /> 201 amps m ~ ~ ~.~ 2 <br /> <br /> ~: D. BranchCir~Rs <br /> <br /> a) ~e fee for b~ch c~ui~ wi~ <br /> ~rchase of settee of feMer fee <br /> ~ bran~ c~uit $ 2.~ <br /> <br /> b) ~e fee for branch cimults wi~out <br /> <br /> Rmt brach cko~t $~5,~ <br /> ~ch addit~nal brach c~t $ 2.~ <br /> <br /> ELECTRICAL PERMIT APPLICATION - -'~PR!2 01! <br /> .,..o,,o.,,,,o,,, .,, , ,,,,.ouo, '% <br /> <br />I. LOCATION OF INSTALLATION BUILDING INSPI <br /> <br />~bA,~,~ ~10 At~4)%T' Au,~Vu.~,T ~c. <br /> <br />Diog:tiom <br /> <br />PERMITS ARI~ NON-TRANSFERABLE AND EXPIRE IF WORK IS N.~. <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF ! : <br /> WORK IS SUSPENDED FOR 180 DAYS, r <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />ElectricalCcmraetor/H'/,--~tC~-- _~/b,~ g-.O [ Phone ~'o5 <br />MailingAddress'7"~qO ~t,O ~.JI,~o~A~.~ ~ <br /> <br />I Phone <br /> <br />property Owner <br /> <br />Contri¢tor'sLi¢~nseNo. 20'- tqc) Z-L5 <br />Contractor's Boarg Reg. NO, ~ t-~CP ] t./ [ Job No, <br />Signature of Supervising Electrician ~ ~,,~~ <br />Supervisor's License No. OM "S, ~ ) ~L-~~J [ Phone~v~ <br /> <br /> 2B. FOR OWNER IIqSTALLATIONS <br /> Property Owner (ple~seprint) <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />E, Miscellaneous (8~rvi~ or F~d~r N~ Included) <br /> Each pump or irrigation eir01e <br /> Each sign or outline lighting ~., <br /> Signal circuit(s) or a limited cnerg7 <br /> panel, alternfion or extension <br />F, Each additional Inspection <br /> Ov*r the allowable in any of the <br /> above, per Inspection <br />O. Minor [n~tallslion Labels <br /> Pack of 10 labels @ $5,00 each <br /> (sold only to electrical contractors) <br />H. Other <br /> (As requir~d by Build/rig OIT~iM) <br /> Amora Dwelliog Et~ctfical <br /> Dwelling Permit Label <br /> <br />$40.00 2 <br />S40.00 ~'-2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />__..sq, fl.x$.04 =__ <br /># of Eab¢ls HtC <br /> <br />5. FEE5 <br />Al. EntertotaloffeesfromSec.#4 $ ol>f ~' <br />A2. Add5% surcharge (.05 x Al) $'~-'~-- <br /> ~btotal $ <br /> <br /> B. Enter25% oflin~Al forPlan Review <br /> (Sec. 3), ir requi~d ' <br /> <br /> D. Reimp*ction Fe* ($25.~) $~ <br /> ~T~ ~0~ D~ $ ~ ~ <br /> Receipt <br /> No. <br /> <br />MC L~-34 12/94 <br /> <br /> <br />