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, "' ~ MARION COUNTY BUILD,lNG INSPECTION <br /> FOR OFFICE USE ONLY - ~ <br /> Received by- 220 High S~t ~ ~ <br />1~ ~' I Salem, ~egon 97301 I~ I <br /> <br /> ELECTRICAL pERMIT APPLICATION ' I O Date: .. <br /> Please complete all Sections, I through 5 I . _ <br /> <br /> L GOCATION OF IN~AB~TION v~ ~ 4 ~E SCBEDULE (Complete <br /> Sob Address <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPII~.E I2~ WORK I$ NOT STARTED WITIffN 180 DAYS OF ISSUANCE <br />OR I~F WORK IS SUSPENDED FOR 150 DAYS. <br /> <br />211. POR OWNER INSTALLATIONS <br /> <br />Cily/Statef~p <br /> <br />The installation i~ being made on property l Own which is n~ inu:nded for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review serv/ce if you complete Section <br /> 5B and submit two (2) sets of plans and specifications <br /> dfis 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 thc Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br />A. Rf~identlal Per Unit <br />Service Included: <br /> <br />1000 sq. fa or le~s ........ $85.00 <br />Each additional 5~ sq, ft. <br />~~]~ ~of $15.00 <br /> <br /> 200 aml~ or less $50.00 ..... 2 <br /> 201 amp~ to 400 amps $60.00 _. 2 <br /> 401 amp~ m ~ amp~ ........ <br /> ~lam ml~ ~ $130.~ ~ 2 <br /> ~er 1~ ~ps or volts $300.~ 2 <br /> Re~ecl ~ly $40.00 <br /> <br />C. Tem~rary <br /> <br /> 2~ ~p, orlcss $35.00 ~ 2 <br /> ~0l ~p~ to ~ amp~ $40.00 ~ 2 <br /> 401 ~p~ Io ~ amps <br /> <br /> a)~ f~ f~ branch mrc~ts <br /> <br /> ~ch b~ch circuit <br /> <br /> First b~nch citCUfi ....... <br /> ~C~ ~d[fional ~nch ciremt <br /> <br />E. M~sc¢lan~us (Servke or ~eeder Not ~duded) <br /> <br /> Pack of 10 la~ls ~ $5-~ ~ad~ $50.00 <br /> <br /> FEES <br /> <br />A 1. Enter tolal of fees from Sec. ~4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of llne Al for Plan Review <br /> (Sec. 3). if req. tqred <br />C. InvestigationFee (ff required) <br />D. R¢inspccfim Fee ($2~.(Xt) <br /> <br /> 'IOTA[. AMOUNT DUE <br /> <br />$ /2&,~ <br /> <br />MC 15-34 II/91 R¢cci¢ No. <br /> <br /> <br />