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FOR OFFICE USE ONLY <br />Received by: _. <br />,,,Date: ~ ? <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 1 <br />ELECTRICAL PERMIT APPLICATION ] <br />Please complete all Sections, I through 5 I <br /> <br />LOCATION OF INSTALLATION <br /> <br />Directic~$ <br /> <br />, <br /> <br /> O~ ~F WORK tS 3USFE~DED EOR 1 ~0 DAYS, <br /> <br /> 2A. CONTRACTOR iNETALLATtON ONUY <br /> <br />pwp~tty Owner <br /> <br />2B, FOR OIYNER INSTALLATIONS <br />Property Owner <br />Mailing Address ,, Phone <br />City/State/Z{p <br /> <br />Ow/lees Signature <br /> <br />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 Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />-220 High Street NE <br />Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:3Cpm "= I-~ <br /> F~; 588-7948 SITE ~: ~ ...... ' <br /> <br /> Date: <br /> Issued by: ~) jUL17 199' <br /> <br />A. Residential Per Unit <br /> Selwice Included: <br /> <br />Number Of Inspections per permit allowed ---] <br /> / <br /> Items Cost (each) Sum/ <br /> <br /> $8500 4 <br /> <br />1000 sq. ft, or in~s <br />Each additional 500 sq. ft. <br />or pottioo thereof $15.00 <br /> $20.00 __ 1 <br />Limited En~ <br />I~aeh Manu~cI ~lome or Modular <br /> t <br />Dwelling Servi~ or Feeder ' $40,00 <br /> <br />B, Servlee~ or Feeders (Does not iulcude branch circult~, ~ee section <br /> <br />200 amps or less <br />201 amps to 400 ampa <br />401 amrnp:~ to 600 amp~ <br /> <br />b) The f~e for branch dreuts without <br /> <br /> ( As reqgired by Building Official) <br /> <br /> ~50,00 __2 <br /> 60.00 __2 <br />$100.00 2 <br />$130.00 __ 2 <br />$300.00 __ 2 <br />$4o.oo ~ <br /> <br />$35.00 __2 <br />40.00 <br />~80.00 <br /> __2 <br /> <br />$2,00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40,00 2 <br />$40,00 2 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$$0,00 <br /> <br />5. FEES <br /> Al. Enter total of f~es from Sec, #4 <br /> AZ. Add 5% surcharge (.0S xA1) <br /> <br /> Subtotal <br /> <br /> B. Enmr 25% of line A1 for Plan Review <br /> (Se~. 3). if <br /> C. ~vestlgafionFee (if required) <br /> D. Reinspecfion Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br /> <br />$ <br /> <br />Receipt No, <br /> <br /> <br />