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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 l.-I~gh SU~t NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 am - 4:~Opm <br /> Codc-A-Phon~: 588-7904 <br /> FAX: 588-7948 <br /> <br /> I <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> I <br /> <br />L LOCATION OF INSTALLATION <br /> <br />IobAddmss <br /> <br />Description <br /> <br />pEILMITS ARE NON-TRANSFERABLE AND NON-R~NDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WlTI-HN 180 DAYS OF ISSUANCE <br />OR IF WORK 15 SUSPENDED FOR lS0 DAYS, <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Property Owwr <br /> <br />Mailing Address <br />CitylSt ate/Zip <br /> <br />The installation is being made on p~opcrty I own wIdch is n~t inmnded for sale, <br /> <br />Owner's $ignatur~ <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Wc will provide plan review service if you complete Section <br />5B and submit two (2) seks 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 gtmcmml <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />S,TE#: I&l } <br />Date: <br /> <br />Issued by; <br /> <br />4. FEE SCHEDULE (Complete ~md enter total ~ A l <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> Each a~aonal 5~0 sq, ff. <br /> or portiere thereof $15,00 -- <br /> Linalmd Eneggy $20.00 <br /> Each Manu£d Home or Medular ,~ <br /> Dwelling Servlc~ or Feeder ~ $40,00 <br /> <br />B. Sa~vlees or Feeders (Do~s not inlclld~ branch ¢i mcits, see a~¢tiotl D) <br /> Installation, AItsratlons or Relocation <br /> 200 amps cc less $$0.00 <br /> 201 amps to 400 a~ps SBO.00 <br /> 401 amps to 600 amps $~00,00 <br /> 601 amps to 1000 amps $~ 80.00 <br /> Over 1000 amp~ or volts __ $~00.00 <br /> R~connect c~ly $~).00 __ <br /> <br />C. Temporary Services/lenders <br /> <br /> 2(10 amps or l~ss <br /> 201 amps to 400 amps <br /> 401 am sto600 am <br /> Over ~ amps or 1~0 volts <br /> <br />D, Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) Th~ fee for branch circuits with <br /> pumhaac & ~crvlcc or fccdcr fcc <br /> <br /> Each branch cin~it <br /> <br /> b) Thc fcc for branch circ~[; withont <br /> <br /> Pint branch circai[ <br /> Each additional branch circuit <br /> <br />E, MJacellaneeus (Service or Feeder Not Included) <br /> Each p~mp cc irrigation ckclc <br /> Each sign or outlinc lighting· __ <br /> Signal circuit(a) or a limited energy <br /> <br />F. Each additional Inspection <br />over the allowable in any of the <br />above, per Inspecaon __ <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labcla @ $5.00 each <br /> (~old only to electrical coraractom) <br /> <br />H, Other <br /> ( As required by Building Official) <br /> <br />$35.00 __2 <br />$40,00 __2 <br />$80.00 __2 <br /> <br />$2.00 <br /> <br />$35,00 <br /> $2.oo <br /> <br /> 40.00 <br />~40.00 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br />Al, Enter total of fees from Sec. 04 <br />A2, Add 5% sumharge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25%of 1/heAl for Plan Review <br /> (S~. 3), if ~q~ <br />C, ~v~ga~onFee ~mqu~d) <br />D. R~s~Q~ Fee ($~,00) <br /> <br /> TOTAL AMOU~ DUE <br /> <br />Receipt No, <br /> <br /> <br />