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I FOR OFFICE USE ONLY <br /> Received by: <br />I Date: ~- , i <br /> <br /> ELECTRICAL PERMIT APPLICATION <br />mp!ete all Sections, I through 5 <br /> <br /> N OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High $~eet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 ara - 4:30pm <br /> Codc-A~]Fholle: 588-7904 <br /> FAX: 588-7~48 SiTE #: <br /> <br /> Date: <br /> <br />DimctJon~ <br /> <br />pERMITS ARE NON -TRANSFERABLE AND NON-R.EFUNDABI~ AND <br />EXPIRE IF WORK IS NOT STARTED x3,rlT~ 180 DAYS OF iSSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />gA. CONTRACTOR 1N.~rALLATION ONLY <br /> <br /> ,. .... ,I <br /> <br />211, FOR OWNER INSTALLATIONS <br />property Own¢~ <br /> <br />Mail~n g Address Phone <br /> <br />CEy/State/Zip <br /> <br />Tho installation is being made on property I own which is not inmnded for sale, <br /> <br />Owner's Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you ~omplete SeC6on <br /> 5B and submit two (2) sets of plans and specifications with <br /> this application. <br /> <br />This optional plan review program does not saspend the <br />required sitbmission of lighting power calculations, plans, <br />and specificaQons whoa required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />4. FEE SCHEDULE (Complete and *1, ~.r ~otal in A 1 below) <br /> Number of Inspections per permit allowed ~] <br /> <br />A. <br /> Residential <br /> ~r <br /> Unit <br /> <br /> 10~ sq. ~ ~less $85.00 4 <br /> Ba~ ad~6onal 5~ s~, fl, <br /> ~imd Enemy $20.00 1 <br /> ~h Manufd Hme or M~ulsr <br /> Dwc~g Se~ ~ Feeder ,, $40.00 2 <br /> <br /> , Sir~i~ or Feeders ~o¢s ~ot ~lcude branch ci~ts, see ~ecao~ D) <br /> l~lation, ll~erationf ~ Rdca~ion ~ ~ <br /> ~ am~ or l.=s ~ ~50.00 ~ ~ ~ <br /> ~* 201 am~ ~ 4~ amps ~ $60,00 2 <br /> <br /> 401 amps 1o 600 mnps <br /> ~01 amps Id I000 amps <br /> Ow.r 1000 mp~ or <br /> R~ot rely <br /> <br /> C. Temporary Service~ers <br /> <br /> 2~ mps or les~ <br /> ~1 ~ps to ~0 amps <br /> 40I m9~ to ~0 am~ <br /> ~e~0 ~p~ or 10~ volts <br /> <br /> D. Branch Cl~uiLs <br /> <br /> potash & ~em,~ Or fc~er fe,e <br /> <br /> Each bm~ ~ult <br /> <br /> b) ~e f~ for ~anch ~rcuts <br /> ~mhase of ~e~le~ or fa¢O~r fee <br /> <br /> ~l pomp ~ i~iga6~ <br /> ~ch si~ or ou~ hgh~g <br /> <br /> F, Each addltlonat Insp~tloa <br /> a~vc, per <br /> <br /> ~ck g 10 la~$ ~ $5.~ <br /> <br /> ~ As ~q~red by Buildi~ <br /> <br />..... g, FEES <br /> <br />$500.00 2 <br />$180.00 __ 2 <br />$300.00 2 <br />$40,00 2 <br /> <br />$35,00 <br />$40,00 <br />$8O,OO <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. Enter total of fees from Sec, <br />A2, Add 5q'o ~urchaege (,05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Se.c, 3). if r~quir~ <br />C, Ymv~tigationFee (ffrequired) <br />D. Rcinspe. caon Fcc ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt NO, , , <br /> <br />$¥ z. <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />