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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br /> I <br />ELECTRICAL PERMIT APPLICATION ~ <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> phone $85-5147 8:00 ma - 4:30pm <br /> C~xle-A-Phone: 555-7904 <br /> FAX: 58s.7~48 SITE #: <br /> <br /> Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />PERMITS ARE NON-TRANSFeRABLE AND NON-PJ~FONDABLE AND <br />EXPIRE II~ WOP-.K IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR/Y WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR iNSTALLATION ONLY <br /> <br />No. 2- ~- I, ~, <br /> <br />, -75~q~2.o71 <br /> <br />~'ob No. <br /> <br />Mailing Address Phone <br />City/StateqZ~p <br /> <br />'File illstatlation ia be. lng mad~ on p~pe~t7 1 own whlc~ is no~ int¢llded for sale. <br /> <br />Owners Signatu~ <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 />mquire<l submission of lighting power calculations, plans, <br />and specificadoas when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC I5-34 11/91 <br /> <br /> 4, FEE $CBIEDULE (Complate and eater total/n A 1 below) <br /> <br /> A. <br /> R~ldentlal <br /> Per <br /> Unit <br /> <br />~ ~ ~ ~emof $15.00 <br /> <br /> ~ Manufd H~a or M~ulat <br /> Dwe~g Se~ ~ Feed~ ~ $40.00 ,2 <br /> <br /> ~. Ser~ 0r FeVers ~s not ~l~de branch civets, see sec~o~ D) <br /> Ins~llation~ AIt~a~ons ~ R~ation <br /> <br /> ~er 1~ ~ps or volts $~0,00 <br /> Re~ct ~y $40.00 2 <br /> <br /> 2~psor~ss $35,00 -- 2 <br /> 201 ~ps to ~0 amps $40,00 <br /> ~1 ~pS tO ~0 am~ ~ $80.00 <br /> ~ ~er ~ ~p$ Or 1~ vO1B <br /> <br /> D. Branch Cimul~ <br /> New, AR~atlon, or ~t~slon Per Panel <br /> <br /> a) ~ f~ for bmn~ <br /> purchase of sc~ ~ g~¢r fee <br /> <br /> b) %e f~ f~ ~ drcuta wi~9,~ <br /> <br /> F~t bra~ cimait $85.00 <br /> Each ~di~fl bra~h c~uit $2.00 <br /> E. Ml~llan~s (Servi~ or Feeder Not Influded) <br /> ~ach ~mp ~ i~ga~ clinic .-- $40.00 <br /> Each slgmbt ou~ne lights $40,00 -- 2 <br /> Signal ~itO) or a ~d <br /> <br /> F, ~ch ~ddaionM Insertion <br /> ~r ~e allowable ~ ~y of ~e <br /> <br /> O. Mtn~ Ins~llatlon Labels <br /> Pack d I0 h~s ~ $5.~ ~&, $~0.~ <br /> <br /> H. Ot~r <br /> ( A, ~qtd~d ~ 3uildisg O~c~l) <br /> <br />$. FEES <br /> Al, Emer total of fees lmm Sea #4 <br /> A2, Add 5% mr~a~e (.05 <br /> <br /> B. En~r ~% of ~ne A1 for <br /> (S~, 3), if <br /> C. ~v~t~ati~Fee (ff ~Uff*d) <br /> D, Rms~m Fee ($~,00) <br /> <br /> 2DTAL AMO~ <br /> <br /> <br />