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FOR OFFICE U'~E ONLY... <br />[ Receiv~ed by: <br />L ate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone $$8-5147 8:00 am - 4:30pm <br />Code-A-Phor~: 588-7904 <br /> FAX: 555-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION' <br />P/ease complete all Sections, I through 5 <br /> <br />SITE#: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />1. LOCATION OF INSqfALLATION <br /> <br />Directions <br /> <br />LDescription <br /> <br />PERMITS ARE NON-'fRANSFERABLE AND NON-REFLrNDABI.~ AND <br />EXPIRE IF WORK IS NOT STAP, TIeD WITHIN 180 DAYS OF ISSUANCE <br />OR/F WORK IS SUSPE. NDED FOR 180 DAYS, <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pml~ny Owner <br /> T <br />Mailing Address /Phone <br /> t <br /> <br />i'City/St atedZip ........ <br /> Thc installation is being mad~ on pmpe,~y I own which is pot intended for sale, <br /> <br />Own&s Signature .. <br />3. PLAN REVIEW SECTION <br /> <br /> We 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 />required submission of lighting power calculations, plans, <br />aud specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC ]5-34 11/91 <br /> <br />4. FEE SCHEDULE (Comploto and enter total in A1 below) <br /> <br />A. Resldentla! Per Unit <br /> <br />$85.00 4 <br /> <br />$15.00 <br />$20.00 -- 1 <br /> <br />}~ach ManuPd Home or Modular <br />Dwelling Servic~ or Feeder $40.00 <br /> <br />g. Servtc~ or Feeders (Do~s not inlcude Imanch circuit~, see ~ecfion D) <br /> <br /> Installation, Alterations or Relocation <br /> 200 amps or less <br /> 201 ~nps to 400 <br /> 401 amps to 600 amps <br /> 601 amps to 1000 ~mps <br /> <br />C. TempOrary ServlcedFeeders <br /> <br /> 200 amps or less <br /> 201 amps to 400 amp~ <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 volts <br /> <br />D. Branch Circolt-q <br /> <br /> a) The fee for branch circuits with <br /> <br /> gach branch cJzcuit <br /> <br /> b) Th~ fe~ for branch drcots without <br /> <br /> F~t branch circuit <br /> Each addi6onal branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> !~ach pamp ~ inigafion cir~l~ <br /> Each sign or oatline lighting <br /> Signal ciz~uit(s) or a limited energy <br /> panel, almratlon or e, xtcudon <br /> <br />F. Each edaitin~a] Inspection <br /> over tha allowable in any of the <br /> above, l~r Inspection <br /> <br />O. Micor Installation Labels <br /> Pack of 10 hbds @ $5.00 each <br /> <br />H. Other <br /> (As req~ed by ~uilding OfflclaO <br /> <br /> ~s0.oo <br /> 60.00 <br />$100,00 <br />$130.00 <br />$300,00 <br />$40,00 <br /> <br />$35.00 <br />$40,00 __2 <br />$80.00 __2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40,00 2 <br />$40.00 2 <br /> <br />$40.00 __2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />Al, ;~',~3t cr uxal of fees imm $e~. #4 <br />A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B, Bnter 25% of llne A1 for Plan Review <br /> (Sec, S),if mquix~d <br />C. Inve.stlgatlonFee (iLrequimd) <br />D. Relnspeefion Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No ...... <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />