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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />I MARION COUNTY BUILDING INSPECTION <br /> 220 High Stxeet NE <br /> Salem, Oregon 97301 <br /> Phone $88-$147 8:00 am - 4:30pm <br /> Code-A-Phone: 58S-7904 <br /> FAX: 5SS-794S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permk No. <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />DJ.~.cflons <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR I~ WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Super, ocs u,=se No. /~ fi ~ _c <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />No, <br /> <br />Pro~r[y Owner <br /> <br />Ma~llng Address Phone <br /> <br />City/State/Zip <br /> <br />The installat~oa is beJng made on prol~rty I Own which is not intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan rev/ew 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 Stmcttmal <br />Specialty Code, Chapter 53, <br /> <br />MC 15.34 11/91 <br /> <br />4, FEE SCHEDULI~; (Complete and enter total in A I below) <br /> <br /> Se--lee 1nede:ResidentlalluFerdUnltNumber of Inspections per permit allowed <br />A. <br /> <br /> 1000 sq. ft. or less ~ $8~.00 ....... 4 <br /> E~ ad~on~ 5~ sq, It, <br /> <br /> L~md ~e~y $20,00 <br /> B~ Manufd H~e ~ M~uhr <br /> Dw~ng Sc~ or Feeder $40,00 2 <br /> <br />B. Ser~ or Fee~ers (Does no~ ~leade ~nch circ~ts, see aecfi~ D) <br /> ins~llatlon, Air.efforts or Rel~atlon <br /> ~ amps m less $50,00 <br /> ~1 amps m ~ mpa $60,00 <br /> <br /> ~r 1~ ~ps or volts $300,00 <br /> ~ect rely $40.00 __ 2 <br /> <br />C, Temporary <br /> <br /> 2~ ~ps ~ less $35.00 __ 2 <br /> 201 ~ps to ~ am~ $40.00 __ 2 <br /> 401 ~ps to ~0 am~ $80.00 ~ 2 <br /> ~er ~ amps o~ 1~ vol~s <br /> <br /> N~, Altffatlon, or ~tenslou Per Panel <br /> <br /> ~ b~ ~mult $~,00 <br /> b) ~ f~ for ~ ~rcuts d~out <br /> <br /> F~t b~nch clrcui~ $85.00 <br /> <br />~, Miscellanies (Service or Feeder Not Included) <br />E~ch ~mp or ~g~fi~ drc1~ $40,00 ~ 2 <br />~ch sign or o~e 1~h~g $40,00 ~ 2 <br />~i~nal circuit(s) ~ ~ ~d e~y <br /> <br /> Pa~ ~ 10 h~s ~ $5.~ ea~ $50.00 <br /> <br />5. FEES <br /> Al. Enter total of fees from See. #4 <br /> A2. Add 5% sumha~ge 605 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25%o£11acA1 for PlanReview <br /> (See, 3). if r~qtfir~d <br /> C- IhvestigationFee (if t~xl~red) <br /> D, Reinspeetion Fee ($25.00) <br /> <br /> TO'I~,L AMOUNT DUE <br /> Re~i?~ No ........ , ..... <br /> <br /> <br />