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FOR CiTY VALrDATIONI <br />K~c~iv~d by:, <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 LANCASTER DR NE ~ SUITE C <br /> SALEM OREGON 97305-1398 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone ~88-5147 8:0Dam - 4:30pm <br />FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS A RI~ NON-TRANSFERABLn AND EXPIRE IF WORK IS NOT <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANC~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />23.. CONTRACT.~R INSTALLATION ONLY . <br /> <br />FOR O~rN]~ INSTALLATIONS <br /> <br />Properly Owner (pleas*prat) <br /> <br />Mailing Address ] Phone <br /> <br /> City/StatdZip <br /> <br />Owner's Signat urn: <br /> <br />3. PLANP~VIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and subnlit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-341/96 - <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. I:~, ,,~CI4 I~i}LILE (complete and em~ tolal in A i t~low) <br /> Number of ~ ~ ~it al~wed <br />~ R~id~tial ~ Unit <br /> ~vi~ In~d~: Itc~ ~t (each) <br />I~.~ $85.~ 4 <br /> <br />~i~d ~cr~ $20.~ "'1 <br />~ch M~fa~ H~ or M~I~ <br /> <br />B. ~ ~ F~s ~ ~t ~clu~ <br /> <br /> 601 amps to 1000 amps $130.00 -- 2 <br /> <br /> P. cconnect o~ly $40.00 2 <br /> <br /> 200 aml~ or le~ $35.00 <br /> 201 am{~ to 400 amps $40.00 2 <br /> 401 ampa to 600 am~ $80.00 __2 <br /> <br /> Each branch ¢i~ult $ 2.00 <br /> <br /> ~ach addltloaal brauch cimuit $ 2.00 <br /> <br /> Each pump or in'ignfion cimle <br /> Each sign or outllae lighting $40.00 2 <br /> Signal ¢imult(s} or a limited energy <br /> <br />F. Bach additional In,,ed:inn <br />above, per Imp~tlon $$5.00 -- <br />Pack o~ Il) labels O $5.00 each $50.00 -- <br /> <br /> (As required by Bttil~tlg O~cisO <br /> <br /> sq. fi. x $. 068 =__ <br />#0fLaSh <br /> <br />FEnS <br />A I. ~ntcr Iotalof fe~ from $~. I/4 <br />A2. Add 5% sutvhmge (.05 x Al) <br /> <br />B. Eats25% ofllneAl for PlanReview <br /> (S~. 3), if r~quir*d <br />C. Inveafignfioa F.~ (ifrequlmd) <br />D. Reiaspectiou Fe~ ($25.00) <br /> <br /> TOTAL AMOUNT DUR <br /> t~ip~ No. <br /> <br /> <br />