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FOR. OFFICE USE ONLY <br />Reeewed by: <br /> <br /> ELECTRICAL PE RMIT A?PI.JCATiON <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />L LOCATION OFINSTALLATION <br /> <br />PERMITS ARE NON-TRANSFEP, ABLE AND NON-REFUNDABLt~ AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN lS0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />property Owner <br />Mailing Address Phone <br />City~tat~d~p <br /> <br />Th~ imtalhaon is being m~d~ on propeay I own which is n~x intendcd for sale. <br /> <br />PLAN REVIEW SECTION <br /> <br />Wc 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 Cede, Chapter 53, <br /> <br />MC 15-34 11191 <br /> <br /> 220 High Streq NE <br /> Salem, Or~ egon 97301 <br />Phone 588-5147 8:00 ~n - 4:30pm <br /> Cod¢-A.Phone: <br /> FAX: 588.7948 <br /> <br />SITE#: APR O 8 <br /> <br /> .BUILDING NS~ECT l)~ <br />issued Dy: , ,,,,,,,, <br /> <br />4, FEE SCHEDULE (Complete and enlrr total in A l below) <br /> <br />A. Residential Per Unit <br /> Servlct~ Included: <br /> <br />1000ssa, fL or less <br /> <br /> 201 am~ w 4~ ~ps ~ $~,00 <br /> <br /> ~1 amps m 1~ a~ $~90.~ <br /> ~er 1~ ~p~ ~ volts $300,~ ........ <br /> <br /> Each b~ch c~ua <br /> <br /> ~n~, Mtent~ or e~t~si~ $40,00 <br /> ~er ~c a~ab~ ~ ~y of ~e <br /> <br /> ( As ~q~red by Building Offic~l) <br /> <br />$85.00 -- 4 <br /> <br />$15.00 <br />$~.00 1 <br /> <br /> FEES <br />A 1, Enter total of fees from Sea #4 <br />A2. Add 5% surcha~ (.05 xAt) <br /> <br /> Subtotal <br /> <br />B, Enter ~5% of ~ine Al for Plan Review <br /> ($~. 3), if required <br />C, lnvesdgationFee (ffrequi~d) <br />D. Reinspeefion Fee ($25,00) <br /> <br /> TOTAl, AMOUNT DUE <br /> <br />Receipt No. . <br /> <br /> <br />