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~ONLY <br />~ Received by:_ <br /> Date:_ _ -- . <br /> <br />ELECTRICAL PERMIT APPLICATION' <br />Please complete all Sections, 1 through <br /> <br />MARION COUNTY_BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phon~ S85-5147 8:00 ~m - 4:30pm <br /> Cede-A-t~aone: fi85-7904 <br /> FAX: SS8-7~45 SITE #: <br /> <br />PERMITS ARE NON-TRANSFfiRABLlg AND NON-RI~FLFNDAB Lg ~ <br />IX~g IF WORK IS NOT START~ ~ 1 ~ DAYS OF ~U~CE <br />OR IF WORK I$ $US~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B,'FOR OWNER INSTALLATIONS <br /> <br />Pro~t~y Own*r <br />Mailing Address [Phone <br />(~tyP&at~/Zip <br /> <br />Th~ ~stalhfi~ is berg ma~ ~ ~ I own wNch i~ ~ ~ for <br /> <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 /> and specifications wi~cn required by the Oregon Structural <br /> Specla/ty Code, Chapter 53. <br /> <br />MC 15.34 11/9] <br /> <br />Date; <br /> <br />Permit No, <br /> <br /> Issued by: <br /> <br />4. FEE SCHEDULE (Complete and cl*ter total in A1 below) <br /> <br /> / <br /> Items Cost (each) Sum! <br /> <br /> __ $15,00 <br /> <br />A, R~identla! Per Unit <br /> Service Included: <br /> <br />I000 sq. fi, or less <br />Each ad~iitlonal $00 sq, <br /> or portion thereof <br />Limited Energy <br /> <br />Each Manufd Home or Meduhr <br /> Dw~tling 8¢~rice or Feeder <br /> <br />~. S~s or Feeders (D~s not inl~u~ ~nch <br /> In~lhflon, Al~atlons Or Rel~aflon <br /> <br /> ~1 m~ w 4~ ~ps ~ $~0.00 <br /> ~l m~ m 6~ ampa ~ $100,~ <br /> ~1 am~ to l~am~ <br /> ~ 1~ mp~ or ~olt~ $300.~ <br /> R~=~ rely $40,00 <br /> <br /> 2~ ~ps or l~ss ~ $35.00 <br /> 201 ~ps to ~ amps <br /> 401 ~p$ to ~0 ~ - $~,00 <br /> ~[ ~ amp: Of ~0~ volt~ <br /> <br /> a) ~ f~ for ~ch ~ ~ <br /> <br /> b) ~ f~ for braaeh ~r~ta ~ <br /> <br /> Fi~t ~ ~uit <br /> <br />E, MIs~lla~us (~rvl~ or Feeder Not IncJnded) <br /> <br /> ~cI, Mt*rad~ or ~tmsi~ <br /> <br /> ~ve. p~ ~ <br /> <br />H. Othe~ <br /> <br /> A2, Add 5% $ur~a~ (,05 x Al) <br /> <br /> Sub~m _ ~ $ <br /> <br /> B. ~ntar ~%of~e A1 f~an R~v~w <br /> (S~. 3). ff ~r~ <br /> Cl ~v~figatlon Fee (ff~qu~ <br /> <br /> R~cei¢ No. . <br /> <br /> <br />