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Received By: <br />Date: <br /> <br />FOR CITY VALIDATION <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 S88-5147 8:00ara - 4:30pm <br /> FAX $88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PROPERTY OWNER <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br /> STARTED WITI~IN lgO DAYS OF ISSUANCE OP. IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Contractor <br />Mailing Address City <br />Supervisor License S <br />Signature of Supv. Electrician <br /> <br />2B. FOR OWNER INSTALLATIONS <br />FropertyOwner(pleaseprint) <br /> <br /> City, State, Zip ~ ~t~'~ ~ __~ <br /> <br />3. PLAN REVIEW 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 submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-34 7/97 <br /> <br />I <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4, FEE SCHEDULE (Cor~l~ and en~r total ill Al <br /> <br />A. Residential Per Unit Number of Inspections por psrmit alloyed ~ <br />Serviee Included: Items Co~t (each) Sum <br />1000 sq. ft. or less $85.00 __ 4 <br />Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br />Limited Energ~ ~ $20.00 <br />Each Manufacto~l Home or ~ <br />Modular Dwelling Service or Fe~ler $40.00 2 <br /> <br />B. Services or Fe~ders (l)~s no{ Im:lude branch e.J~ui~, see s~flon D) <br /> <br />200 amps or less $50.00 __ 2 <br />201 amps t~ 400 amps $60.00 2 <br />401 amps to 600 amps $100.00 __ 2 <br /> <br />5. FEES <br /> Al. Enter total of fe~s from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reimpeodon F~e ($25.00) <br /> <br />Recalpt NO. <br /> <br />Subtotal <br /> <br />TOTAL AMOLr/qT DUE <br /> <br /> <br />