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FOR OFFICE USE ONLY <br /> Received by:_ <br />I Date: ~' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRiCALPERMITAPPLICATION <br />I <br />Please complete afl Sect/ohs, I through 5 <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br />SiTE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />PERM]'£$ ARE NON-TRANSFERABLE AND NON-RBIqJNDABLE AND <br />E~E W WO~ I~ NOT ST~T~ ~ 180 DAYS OF <br />OR W WO~ ~ SUSP~ED FOR 180 DAYS. <br /> <br />2A, CONTRACFOR IN~ALLATION ONLY <br />~le~cal C~tm~r m Ph~c <br />Mailing Adfl~s~ <br /> <br />~c insod~ is bcJ~g mad~ on p~y I own w~ is n~ intended for sale, <br /> <br />Owner's Signature .... <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets 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 calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Cgde, Chapter 53. <br /> <br />4, FEE SCHEDULE (Complete and enter total ~ A 1 below) <br /> Number of' inspections per permit allowed -~ <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: items Cost (ea~) Sum! <br /> <br />1000 sq- fL or less $85.00 4 <br />Each ad01fional fi00 gq, fi, <br />or ~,~on thereof $15,00 <br />Lirrdtcd Bncrgy $20.00 __ 1 <br />Bach Manufd Itome or Modular <br />Dwelling Semce or Feeder $40.00 __ 2 <br /> <br />g. Services or Feeders (Does not inlcude branch circuits, see section D) <br /> <br />Installation, Alterations or Relocation <br /> 200 amps or less <br /> 201 amps to 400 itmp~ <br /> <br />200 amps or less <br />201 amps to 400 amps <br /> <br />a) The fee for branch e[realts with <br /> <br /> (As r~quired by B ultdlag Official) <br /> <br /> ~50,00 <br /> 60,00 <br />$100.00 <br />$130.00 <br />$300,00 <br />$40,00 <br /> <br />$35.00 __2 <br />$4o.oo __e <br />$80.00 2 <br /> <br />$2.00 <br /> <br />$35,00 <br /> Sa.00 <br /> <br />$40,00 <br />$40,00 ,,, 2 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />s. P£ :s <br /> A 1. Enter total of fees from Sec. #4 <br /> A2. Add 5¢0 sumharge (.05 x Al) <br /> <br /> S~btotal <br /> <br /> B. Enter 25% of I/n~ Al for Plan Review <br /> ($~. 3). if required <br /> C. Investigation Fee (ff mquirod) <br /> D, Re, inspect/on Fcc ($25.00) <br /> <br /> TOTAL AMOUNt' DUE <br /> <br />$ <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br />MC 15-34 11/91 Recei~N,9- <br /> <br /> <br />