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FOR OFFICE USE ONLY <br />Received by:__ <br />Date: <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br />Phone 588-5147 8:00 am - 4:30pm <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br /> 1. IX)CATION OF INSq'ALI,ATION <br /> <br />Dir~d. ons <br /> <br />p EKM~['S AKE NON -q~.ANSFER~BLE AN~ NON-REFUNDABLE AND <br />E~E ~ WO~ IS NOT STATED ~ 180 DAYS OF ISSU~CE <br />OR IF WORK IS S USP~DED FOR 180 DAYS, <br /> <br />ZA. CO~RA~OR [N~I'ALL~FION ONLY <br /> <br />Proper-5' Owner <br /> <br />Cky/SmtefZip <br /> <br />The installation is being made on properly I own which ia not intDndud for sale, <br /> <br />Owner's Signature <br /> <br />3, PI.AN REVIEW SEC'. r'lON <br /> <br />We will provide piton 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 thc <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br /> Dale: ~ O {;~3 <br /> {ssued by: <br /> MARION C0Ura[* <br /> BUILDING INSPECIION <br />4, ~ E SCHEDULE (Complete 0nd enter total in .& l below) <br /> <br /> Number of Insp¢'Cztiuns per permit allowed ~] <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Setwice Included: Itc:mc Cost (each) Sum <br /> <br /> 1000 sq, fu or less ~ $85.00 4 <br /> Each ~dditiona1500 ~q, fi, <br /> or porfio~ the~of .... $15.00 <br /> Limited Energy $20.00 __ 1 <br /> Each Manufd I [omc or Modular <br /> DweLLing Serv/c~ or Feeder ~ $40.00 __ 2 <br /> <br /> 50.00 <br /> 200 amps or less $~160.00 __ 2 <br /> 401 amF,z to 601.'1 atr~ps $100.00 __ 5, <br /> dOl amps to lO0~ amps ~ $150.00 2 <br /> <br /> 200 amps or less $35.00 __ 2 <br /> <br /> b) The fe~ for branch circnts .without <br /> Each ~:mp or ivfigadcm circle ~ $40,00 120'~>2 <br /> <br /> above, per Inspection $35.00 <br /> Pack of 10 }abel~ @ ~$.00 each $S0.00 <br /> <br /> ( A.¢ required by Building Offic~l) <br /> <br /> FEES <br /> <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B, Enter 25% of EnD AI for Plan Review <br /> (Sec. 3), if required <br />C. InvestigationF¢¢ (ff required) <br />D. RelnspecUDm Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MCl5-34 11191 Recei¢ No. <br /> <br /> <br />