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FOR OFFICE USE ONLY <br />Receivcnt by:, <br />Date:. <br /> <br /> 220 }ligh Street I'~ <br /> Salem, O.:egon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />pEP~MITS ARE NON-TRANSFERABLE AND NON-REFUNDABL~ AND <br />EXITIRE ~F WORK IS NOT STARTED WIT!4]~ ltl0 DAYS OF ISSUANCE <br />OR IF WORK I9 SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Pm~ Owner <br /> <br />Contrac~fs Beam Reg. No, O 9 [ ~ <br />S~mtureofSu~is~gE~ ' ~_ <br /> <br />FOR OWNI~R INSTALLATIONS <br /> <br />CAty/St atcLZip <br /> <br />'}'he insta?dafion ~.s being made or) property I own which is nc~ hltended for sale. <br /> <br />O~mer's Siena utc <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review mrvice if you complete Section <br /> 5B and sabmit two (2) sets of plans and specifications with <br /> this application, <br /> <br /> This optional plan review prOgram docs not suspend the <br /> required submission of lighting ~Ower calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 13-34 11/91 <br /> <br />Issued by:BUILDING INSPEC'IlON <br /> <br />4. FEE SCt~EDULE (Complete and enter tmal in A1 below) <br /> <br />A, Residential Per Unit <br /> Service Included: <br /> <br />1000 sq, ft, or ]eSS <br />Each additional 900 sq, fL <br /> <br />Limited Energy <br />Each Manufd iIome or M(xhilar <br /> Dwelling Se~fiee or Feeder <br /> <br />$85,00 ....... <br /> <br />$15.00 <br />$20,00 __ 1 <br /> <br />$40.00 __ 2 <br /> <br />Jl <br /> <br />B. Servlo--s or Feeders (Doc~ not inlcudc braQch circuits, scc $¢¢1,~on D) <br /> <br /> 201 amps to 400 amps <br /> <br /> 601 amps to 1000 amps <br /> Over 1000 amps or vok~ <br /> <br />C. Temporary Services/Feeders <br /> <br /> 201 amps to 400 amps <br /> <br /> a) The fc~ f~r branch circt~s <br /> <br /> Each brmch clrcuk <br /> <br /> b) 'lEe f~ for branch fircms <br /> <br /> ~ach addifi~al branch <br /> <br />E, Miscellanies (Service or Feeder No~ ~nelu~ed) <br /> <br />E Each a~itional Insp~tion <br /> over ~e allowabIe ~ any of the <br /> a~ve, ~r ]~specdon <br /> <br /> Pack of 10 la~ls C~ $5,~ <br /> <br />H. Other <br /> ( As requirtd by B~ilding Officio <br /> <br /> ~90.00 <br /> 60.00 <br />$100,00 <br />$130.00 <br />9300,00 <br />$40,00 <br /> <br />$S5.00 <br />$40.00 <br />$80.00 <br /> <br />$2.00 ~ <br /> <br />$~9,00 <br /> $2.oo ....... <br /> <br />$40.00 ~2 <br />$40,00 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5, FEES <br /> Al, Enter total of fees from S0¢, #4 <br /> A2, Add 5% surcharge (.05 x A 1 ) <br /> <br /> Subtotal <br /> <br /> B. Enter 250/0 of llne A1 for Plan Review <br /> (aSv~c,.; 3!. if required <br /> C. I~ e, tigationFee (if required) <br /> D, Reinspecdon Fee ($25,00) <br /> <br /> '[O'['AL AMOUNT DUE <br /> <br />Re~zeipt No. ~., <br /> <br /> <br />