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IFOR USE ONLY <br /> OFFICE <br /> Received by: _ <br /> ,Date: ~,. <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 555-5147 8:00 am - 4:$0pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />L LOCATION OFINSTALLATION <br /> <br /> ,, v , ...... <br /> <br />E~ ~ WORK IS NOT ST~T~ ~ lse DAYS OF <br />OR IF WO~ IS $U$P~ED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSq'ALLATION ONLY <br /> <br />Mailing Addl~ss · <br /> .... ?de' // <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />PrOl~ay Owner <br />Mailing Address Phone <br />Cky/Stata/Z~p <br /> <br />Thc installation is b~ins mad~ on propar~ I ~.0~n which is ~lot inl~alded for salc, <br /> <br /> Own&s Signature ...... <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B and submit two (2) set~ of plans and specifications with <br /> this application. <br /> <br /> This optional plan review program doe.~ not suspend the <br /> required submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Struet~al <br /> Specialty Cede, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Date: <br /> <br />Permit No, <br /> <br /> Issued by: <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Resldenti~l <br /> Per <br /> Unit <br /> Service Included: Items Cost (¢0~:h) Sum <br /> 1000 sq. ~, or les~ $85.00 <br /> Each additional ~0 sq, ft, <br /> or poniaa thcv:.of $15,00 <br /> Limited Energy $20,00 __ <br /> ]~ach Manu£d Home or MC~tular <br /> Dwelling Se~vic~ or Feeder 540.00 -- <br /> <br />B. Services or Feeders (Dc,~s not inlcudc branch circuits, see section D) <br /> <br /> Instal200 amp~tefl°n'or AIt~ratlonsless or RelOcation <br /> 201 amps to 400 ampa <br /> 401 amps to 600 amps $100,00 <br /> 180.00 <br /> 601 amps to t000 amps $ $800.00 <br /> Over 1000 amps or vohs <br /> Keeotm¢~t ~ly 540.00 <br /> <br />C, l~mporary Servlcer/Feeders <br />Inststlanon~ Alteration, or Relocation <br />2(X) amps or less $35.00 <br /> 40.00 <br />201 amps to 400 amps 5 $80.00 <br />401am sto600ara s <br /> <br />D. Branch Circuits <br /> <br /> a) 'I'b~ fca for branch tin,airS with <br /> <br /> b) The fo: for branch eireuts withou~ <br /> <br /> Each additional branch clreuit $2,00 <br /> <br /> Each pump or irfigatic~ ~rclc <br /> l~ach sign or outline l~ghfing <br /> <br /> paIl~l, alt~ratlon or cxt~naion 5~0,00 <br /> <br /> above, p~r In~pe~tlon $$5,00 <br /> Pack of l0 labels @ 55,00 ca& <br /> <br /> ( As ~quired by Building Official) <br /> <br />5. FEES <br /> Al. Enter total of fccs from Scc. #4 <br /> AZ, Add 5% sutchatg~ (,05 x Al) <br /> <br /> Subtotal <br /> <br /> C, ~nvcsfigaff~ ~ec (ff require@ <br /> <br /> TOTAL AMOU~ DUE <br /> <br />Receipt No, <br /> <br /> <br />