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IFOR OFFICE USE ONLY <br /> Received by:_ <br /> Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> · 2~Q High S~xect NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 ~- 4:30mn <br /> <br /> Date:U1~ ~,. ~- ,,..,.~ '-:-/ <br /> Issued by:~ <br /> <br />Oe,cctiption <br /> <br />PERMITS ARE NON-TIL~rSFERABLE AND NON-RigFUNDABI.~ AND <br />EXPI~I~ IF WORK IS NOT STARTED W1THIN 180 DAYS OF ~SUANCE <br />OF, IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Pro~ay Owner / ] ~one <br /> <br />2B, FOR OWNER INSTALLATIONS <br />Properly Owner <br />Mailing Address Phone <br />City/St ate]Zip <br /> <br />The installation is being made on property I own which is i1o{ intended for sale, <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 />reqnired submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC ]5-34 11/91 <br /> <br /> Number of Iosp~tions p~ permit allowed <br /> <br />A. <br /> R~idenfla[ <br /> Per <br /> Unit <br /> Se~lee Included: a¢~s Cost (each) Sum/ <br /> <br /> 10~ $q, ft, or 1e$s ............ $8~.00 <br /> Each ad~tlonal 5~) ~q. fl. <br /> or ~ni~ the~of $1 fi,00 <br /> ~i~d En~y $20.00 __ <br /> E<h Manufd~o~e or M~ular <br /> Dwe~ng S¢~i~ or Feed~ $40.00 __ <br /> <br /> B. $.rvi~ or Feeders ~oes not ~leude branch ciNuits, see section D) <br /> In.lisBon AIt~a~ons ~ Rel~athin . ~ ¢ }~" <br /> 2~ ~ps ~ less __~ ~S0.00 <br /> <br /> ~1 ~ to 6~ amps $100,00 <br /> ~1 am~ to 1~ amps $180,00 __ <br /> ~er 1~ ~ps or volts $~00.00 <br /> R~nne~ ~y , , $40.00 __ <br /> <br /> 401 ~pa to ~0 amtpa a $80,00 <br /> <br /> Each branch clmuit $2.00 <br /> ~rcha~e of se~iea or ~0~r <br /> <br /> Each pump ~ imgafi~ cimhi __ $40,00 <br /> S~nal Orcuit(a) or a fi~ted me~y <br /> <br />5. FEES <br /> Al, Enter lotai offee~ from Sec. #4 <br /> A2, Add 5% sureha~e (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of tine A1 for Pice Review <br /> (Sec. 3), if required <br /> C, Inve,tigationFee (ff requited) <br /> D, Reh)spection Fee ($25,00) <br /> <br /> Receipt No. , ...... <br /> <br /> <br />