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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High ,~'eet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-~147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Pg~S ~E NON-%~NB~BL~ ~D NON-~NDAB~ ~ <br />EXPIRE ~ WORK IS NOT S~AKTED ~ 180 DAYS OF ISSU~CE <br /> WORK IS SUSpF~DED FOR I sa DAYS. <br /> <br />Supcrvlsofs I ic~nm No. /0 ~ ~ <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />PTe, pe~y Owr~r <br /> <br />Mailing Address Phone <br /> <br />City/State/Zip <br /> <br />The installation is berg made on prolx:rty I own whj.ch is not intended for sale, <br /> <br />3, PLAN REVIEW ~'FION <br /> <br />We will provide plan rev/ew service if you complete Section <br />58 and submit two (2) sets of p 'lans 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 />MC15.$4 11/91 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit NO, <br /> <br />4. I~lgE SCHEDULE (Complete and enter total in A 1 below) <br /> <br />A, Residential Per Unit Number °f Inspections 77 petrol{ all°wed] <br /> Service Included: Items c..osI (each) Sum/ <br /> <br />1000 sq. ft, or less $8S.00 , d <br />Each addltiomll fi00 $q. ft. <br />or posen thereof $15.00 <br />Limited Energy $20.00 1 <br /> <br />Each Manuf'd Home or Modular <br />Dwelling Se~ice or Feeder $40.00 ~ 2 <br /> <br />B. Services or Feeders (Does not mlcude branch circuits, see sect/on D) <br /> <br /> Installation, Alterations or RelOCation <br /> 200 tLmps or less .... <br /> 201 o.m~m to 400 amps ~ $~0.00 <br /> 4el amps to 600 amp~ $10000 <br /> t~l amps to I000 amps <br /> Over 100O amps or volt~ $300.00 <br /> R~connect only $40.00 <br /> <br />C, TempOrary <br /> <br /> 200 arnpa or less $35.00 <br /> 201 amps to 400 amps <br /> 401 anlps to (fi)0 amps <br /> Over 600 m'np~ or 1000 volts <br /> <br />D. Branch Circuits <br /> <br /> a) The fee for branch e~tc0its with <br /> Imreha~g,of service Or l[eeder fcc <br /> <br /> ~c.h br~nch circuit $~,00 <br /> <br /> b)The fee for bra, ch e. ircats without <br /> g3~rphase of se~ce or feeder <br /> <br /> First bnmch circuit <br /> Each additional branch circuh $2.00 <br /> <br />E. Mi~celtsneous (Service or Feeder Not included) <br /> Each l:~Lrap or irri~Afion ckcle .... I $40.00 <br /> Each sign or outline ligh6ng <br /> Signal C&¢uit(s) or a tim/md enemy <br /> panel, alteration or extension $40.00 <br /> <br />F. Each additional Inspection <br />over the aBowable ~a any of the <br />ahoy*, pex ~spccfio'~ ~ $35,00 <br /> <br /> Pack of t0 lab¢l~ ~ $5.00 each__ $50.00 <br /> <br />H. Other <br /> (As required by B~ildi{:g Official) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> AZ. Add 5% ax~rchalg~ (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter.?.5% of lineAl for PlanRcvi~w <br /> (Sec. 3), if re%aired <br /> C, Investigation l,ec (if required) <br /> D, Reinspecdon Fcc ($25,00) <br /> <br /> TOTAL A_MOUN'r DUE <br /> <br />Receipt No, <br /> <br /> <br />