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FOR OFFICE USE ONLY <br />Date: <br /> <br /> ELECTRICAL PERMIT APPLICATION' <br />_.Please complete all Sections, I through 5 <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Code-A-Phone: 588~7904 <br /> IAX: 5SS-7948 <br /> <br />MARION COUNTY BUELDING iNSPECTION <br /> <br /> c~ I lyyg <br /> Date: _. ~;A~iON COUNTY <br /> Issued by~jill fllfd~ ~ ...... <br /> ..... P~ tun <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />P!~RMiTS ARE NON-TR~,NSFERABLB AND NON-REFUNDAIII,~ AND <br />EXI~LB IF WORK IS NOT STARTED WITHIN 180 DAYS OP ISSUANCS <br />OR I1: WORK IS SUSPENDIID FOR I SO DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prol~rty Owner <br />Manilas Addross Phone <br /> <br />Cit¥/StateJZip <br /> <br />Th~ hlstallat/~/~ b~g mad~ on prop~y [ own whick i~ }1o~/nttald~l fo~ s~It. <br /> <br />3. PLAN REVIlgW SECTION <br /> <br /> We will provide plan review serviee 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 />and specifications when required by the Oregon Structural <br />Specialty Code, Chapmt 53. <br /> <br />MC 15-34 11/91 <br /> <br />.4. FEE SCHEDULE (Complet* and enter total in Al below) <br /> <br />A, ReSidential Per Unit <br /> Service Inclndedt <br /> <br />1000 sq. It. or less <br />Each addilional ~00 iq, ft. <br /> or posen thereof <br /> <br />Limlt~l Energy <br />Each Manu£d Home or Moduhr <br /> <br />B. <br /> <br /> ~ $20.00 __ 1 <br /> <br />$~ or Feeders ~es not ~cude ~anch circuit, sca ~ec~ D) <br /> <br /> ~ ~ or less ~ $~.00 ~ 2 <br /> <br /> Rem~t mC $40.00 ~ <br /> <br /> 2~ ~pz or less $35,00 ., 2 <br /> ~1 ~ps to 4~ amps $~.00 2 <br /> 401 ~ps to ~ ~ $80.00 2 <br /> ~ ~ ~pi or 10~ volu <br /> <br />a) ~ f~ foe ~ drafts ~ <br /> pumhase ~ se~,or feast.fee <br /> <br /> ~ch bm~ ~uit ~ $2,~ <br /> <br /> F~t ~ dm~t $35.00 <br /> Each Mdi~on~ b~ch clr¢~[ ~ $~,00 ..... <br /> <br /> ~ ~p ~ ~Sa~ ~e ~ $40,00 ~2 <br /> ~el, alte~fion or e~si~ . $40,00 2 <br /> <br /> a~, ~t ~e~ $35,00 ~ <br /> Ps~ ~ tO h~s ~ $f.~ *a~ .... $~ .00 <br /> <br /> ( ~ ~Eu~rid by BMlding Officio ~ <br /> <br />5, FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter ~% of llne A1 for Plan Review <br /> (Sm, 3). if ~quir~ <br /> C, hv~figat~F~* (ff mqu~d) <br /> D, R~p~ ~ ~,00) <br /> <br /> ~TAL ~OU~ DU~ <br /> <br />Receipt No, <br /> <br /> <br />