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:: Date: <br /> <br />ELECTRICAL PERMIT APPUCAllON <br />Plea~ complete all Sections, 1 ~hrough 5 <br /> <br />1, LOCAllON OF INSTALLAllON <br /> <br />MARION COUNTY BUILDING INSPEC'RON <br />220 Hi2h Sires{ NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8.00 a.m. - 4:30 p.m. <br /> <br /> I Issued by: <br /> FAX: <br /> 588-7948 <br /> <br />Mailing Address I Phone <br /> <br />Ctty/Smte/ZIp <br /> <br />The installation is being made on property 1 own which is not intended for sale. <br />lease or rent,, <br /> <br />Owner's alone Ure <br /> <br />PLAN REVIEW SEC11ON <br /> Check appropriate item and enact fee in ~ 5B. <br /> <br />Connected Load over 200 amps (except single family dwellings) <br />Building system over 200 amps (except single family dwellings) <br />System over 600 vo]t~ <br />Building over2 s~tles <br />I~JildJng over 10,000 ~luam feet <br />Occepaot lead over 3(X) pomona <br />Manufactured Dwelling Park/P,e~mt!on Pa~k <br />HazaJseus !.o~a~ns <br /> <br />Submit 2 sets of plans with any of the above,, <br />Tempormy cef]stn~on sewlces do not apply,, <br /> <br />SITE,: <br /> <br />Da~: <br /> <br />Permit No. ,~,.~ ~) <br /> <br />4. FEE SCHEDULE (Complete and enter total in At below) <br />Number of Inspections per permit eltewM] <br /> <br />A. Residential, Single or item~ x C~t = Total <br /> <br /> Multi-Family per dwelling unit <br /> ($erv/Ce/nc~ded) <br /> <br /> E~h ~'1 ~0 ~, ~. ~ porn <br /> E~h Mig,"d Ho~ or M~lar <br /> D~lling ~ or <br /> <br /> (10~~) <br /> <br /> ~1 <br /> <br /> R~nn~ Only <br /> <br /> ~0~or~ <br /> <br /> ~ ~ ~s or I0~ vol~ (8~ 4B) <br /> D. Branch Clmul~ <br /> <br /> ~h ~d'l ~n ci;ui~ or po~on <br /> <br /> E. Mla~neeus <br /> (~ ~ F~der not <br /> E~h pu~ or I~ga~on <br /> E~ s~n or ouSIne Ilgh~ng <br /> 8~nN clair(s) or a li~t~ ene~ <br /> <br />F. ~eh a~'l <br /> <br /> me ~e, per In~on <br /> <br />H. <br /> <br />__$85. <br /> $ 15 <br /> <br /> $130, <br />,, $~ <br /> <br />__$35, <br />__$40, <br /> <br />__ SSS.__ 2 <br />__$15.__ 2 <br /> <br />At, Enter toteJ of fees from See,, <br />A~, Add5% surcharge (,05xA0 <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec.. 3), if required <br />C, inveslJgalJee Fee (if required) <br />D, Relnspec~n Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br /> <br /> <br />