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fOR omce vse 8NLY ] <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Z~0 High St1~et N~ <br /> Salem, Oregon 97301 <br /> <br /> Phone 58S-5147 8:00 am - 4:309m <br /> Codc-A-phone: 588-7904 <br /> FAX: 588-7948 $1T~ #; <br /> <br />iELECTRICAL PERMIT APPLICATION' <br />Please complete all Sections, 7 through <br /> <br />Descfiptkm <br /> <br />pERMITS ARE NON-11L/~NSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED W1TI-m~ lS0 DAYS OF I$SUANCE <br />OR IF WORK IS SUSPF2qDED FOR ! $0 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />211. FOR OWNER INSTALLATIONS <br />Property Owner <br />Ma/ling Address Phone <br />Ci[y/St ate/Zip <br /> <br />The installation is being made on property I own which is no[ intended for <br /> <br />Owner's Signature <br /> <br />3, PI,AN REVIEW SECTION <br /> <br /> We will provide phm review service it' 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 Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Date: <br /> <br />Porme ~o, <br /> <br />Issued by: <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> Number of Inspections per pertoit allowed --] <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> / <br /> Service Included: Ittans Cost (each) $~tto/ <br /> <br /> $85,00 ..... 4 <br /> l ~ sq. ft, or less <br /> I~ach a/tditiom1500 sq, ft. <br /> c~ potion inereof ........ $15.00 <br /> Limed Energy $20.00 <br /> <br />Bach Manufd Home or Modular <br />Dwell/ag Se~ice or Feeder $40,00 2 <br /> <br /> Services or Feeders (DOes not inlcudc branch circuits, sec sccdon D) <br /> Installation, Alterations or Relocation I ~d ¢' z, <br /> 200 aml~ or leSS $$0.00 - 9 <br /> 201 amps to 400 alllps $~0.00 -- 2 <br /> 401 ~,nps to 6~) ~nps $100,~ 2 <br /> 601 amt~ to 100Oamps $130.00 -- 2 <br /> Over 1000 amp~ or voltz $300,00 __ 2 <br /> Recom~ct only ..... $40,00 __ 2 <br /> <br />a) The fee for branch clrcu/ts with <br /> / <br />b) The, fee. fo~ branch dmuts ~ <br /> <br /> Pack of 10 labels @ $5,00 ~ch <br /> <br /> (As r~qulre4 by Bt~ild~n~ Official) <br /> <br />$35,00 __2 <br />$40,00 __2 <br />$80.00 ~2 <br /> <br />$2.00 'Z ~-c> <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40,00 <br />$40.00 <br /> <br />$40,00 <br /> <br />$35.00 <br /> <br />5, FEES <br /> Al, Enter total of fees from Sec, #4 <br /> A2. Add 5% surchaege (.05 xAI) <br /> <br /> Subtotal <br /> <br /> B, Enter 25%oflMeAI for PlanRcvJew <br /> (Sec. 3),if required <br /> C. In¥ostlgationF~e (if required) <br /> D. Rc~spection Fee C$25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />