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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, O~goa 9~301 <br /> <br /> Pheoe 5~8-5147 8:00 m~ - 4:30pm <br /> FAX: 5SS-794S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />Date: <br /> <br />Issued by: <br /> <br />No, <br /> <br />1, LOCATXON OF INSTALLATION <br /> <br />PERM1TS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTBD ~ 180 DAYS OF ISSUANCE <br />OR IS WORK IS SUSPENDED FOR tse DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONIY <br /> <br />2B, FOR OWN'ER INSTALLATIONS <br /> <br />Property Owner <br /> <br /> Address [ Ph~oe <br />Mailing <br /> <br />City/State/Zip <br /> <br />TI~ insudlaficm is being mad~ on efo~ I oq~ which is not intended fm ~ <br /> <br />Owner's <br /> <br />3. PLAN RE'flEW 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 calculakms, plans, <br />and specifications when required by ~hu Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4, FEE~CHEDULE (Camldete and enter total in Al below) <br /> <br /> Number af Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> [ <br /> Servlc~ ]nchMed: Items Co~t (mwh) ~umt <br /> 1000 sq. fi. or less $85.00 4 <br /> Each additi~d 500 sq, ~ <br /> ~ portion thereof $~5,00 <br /> Limited EnelRy $~0.00 1 <br /> Each Man. fa Home ot Moduhr <br /> Dwelli~ Sen, ice m$~e~ $40.00 2 <br /> <br />B. Se~lc~ or Feeders (Does not inlcnde branch drcu~u, see section D) <br /> <br />$. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add $% surcharge (.05 x Al) <br /> <br /> B. Emer 25%of lineAl forPlanRevi~w <br /> (Sec. 3), it required <br /> <br /> D. Reinspecticn F~e ($2500) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />No. <br /> <br /> <br />