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FOR OFFICE USE ONLY <br />Receh,~d by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Sa'oct NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:3Opm <br /> Code-A-Phone: 588-7904 <br /> FAX: 5ss-794s SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> PermitNo. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />L LOCATION Olr INSTALLATION <br /> <br />Descfipdon <br /> <br />PERMITS AR E NON-TRANSFERABLE AND NON-REFUNDABLt~ AND <br />EXIqRE IF WORK IS NOT STARTED W1TI-IIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACFOR INSTALLATION ONLY <br /> <br />~IP~ny Owner {1 hone <br /> <br />2E, FOR OWNER INSTALLATIONS <br />Pro0eny Owner <br />Mailing Address Phone <br /> <br />City/Slnt¢/Zip <br /> <br />3'he instollalion is being made on property I own which is no~. inmnded fei' sal~, <br /> <br />PLAN REVIEW SECTION <br /> <br />We will provide phm review service if you complete Seeded <br />5B and submit two (2) sets of plans and specifications with <br />this application, <br /> <br />This Ol>tional plan review program does not suspend the <br />required submission of lighting power calculstions, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/9I <br /> <br />4, FEE SCHEDULE (Complete and enter lolal in A I b~low) <br /> <br /> Number of Inspections p~ permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Item~ Cost (each) Sum <br /> <br /> 10~0 sq. ft. or less $85.00 <br /> Each add~fio~a1500 iq. ft. <br /> or pottic~ thereof $15.00 <br /> Limited Energy $~0,00 -- <br /> <br />l~aeh Mmnufd I-lomc or Modular <br />Dwdling Servlc~ or Feede~ ,/ $40,00 ¢ <br />B, Servlct~ Or Feeders (Does not mlcudc branch C, tmlits, sec section D) <br /> <br />200 amps or lcss <br />201 amps to 400 amps <br /> <br /> Each $1gtl or outline .~.,ghtlng __ <br /> <br /> above, per lmpccd.on <br /> <br /> Pack of 10 labels @ ,~,00 each <br /> <br /> (As required by BuiIdlng Official) <br /> <br /> ~50.00 <br /> 60.00 <br />$100.00 <br />$130,00 <br />$800.00 <br />$40.00 <br /> <br />$35.00 <br />$40.00 ... <br />$80,00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 <br />$40,00 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> <br />Al, Enter total of fees from Sec. #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />a. Entcr25%ofllneA1 for Plan Review <br /> (Sec, 3). if i~quired <br />C, ~nvesrigationFee (if required) <br />D. Rein~pectjc~l Fee ¢25,00) <br /> <br /> 'IrYI'AL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />