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I~OR OFFICE USE ONLY <br /> Received by:. <br /> Da~:. <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY' DEVELOPMENT CENTER <br /> 285 Chu~h St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br />Please complete all Sections, 1 through5 JtJ~l ~ ~ !0~' Issuedby: <br /> <br />~ W WO~ ~ NOT ~ ~ 180 DAYS OF ~$U~CE <br />OR ~ WO~ IS SUSP~ FOR lg0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Supe~vlsot'sLic~nseNo. ..~tSp.~/ ~ [PhoneNo. <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner <br /> <br />Ma~i~g Address Phoae <br /> <br />City/S/ate/Zip <br /> <br />The instaHafi(x~ is being made c~ prepeny I own which is not intended for sal~. <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plan~ and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />requirod submission of lighting power calculations, plans, <br />and specifi~fions when required by the Oregon Structural <br />Speelahy Code, Chapter 53. <br /> <br />Permit No. <br /> <br />-'PlE. I ~PE ~CHEDULE (C. omplat e md emer totalin A1 below) <br /> <br /> Number of Inspections per permit allowed <br /> <br /> A. <br /> Re~lentlal <br /> Per <br /> Unit <br /> Sorvlce Included: ~tems Co~t (each) <br /> 1000 ~1. ~ c~ less $85.00 <br /> Each ~difionaI $00 sq. fi. <br /> or ponlm ~he~eof $15,00 <br /> Limited Energy $20,00 <br /> Each Mnnufa ttome or Modular <br /> <br /> B. ~orvkes or Feeders (Do~s not inlc~de bran~ circuits, see ~ctio~ D) <br /> <br /> Installation, Alte~flo~s or Rdectflon <br /> 200 amps orlass <br /> <br /> ~ 1~ ~ps ~ ~ <br /> <br />C. ~m~y S~Ic~ <br /> ~laflo~ AIt~aflon, or Rd~aflon <br /> ~ps or less <br /> <br /> ~er ~ ~s ~ 1~ vo~ <br /> <br />D. Brs~h <br /> N~ Al~aflon~ or ~s~ Per <br /> <br /> a) ~ f~f~ ~ <br /> o~a~ ~ se~ ~ f~cr fee <br /> <br /> ~ b~ ~t <br /> <br /> b) ~ f~ f~ ~ ~s ~o~ <br /> ~m~se ~ s~ ~ f~ f~ <br /> <br /> ~b~ <br /> <br /> ~ ~ or ~ ~ <br /> <br /> ~cr ~ ~able ~ my ~ ~ <br /> <br />G. M~r l~ti~ ~la <br /> Pa~ ~ 10h~ $5.~ ~ <br /> <br />H.~ <br /> <br />$50.00 .'~1~--2 <br />$60.00 -- 2 <br />$100.00 2 <br />$130.00 2 <br /> <br /> $40.00 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$2,0o <br /> <br />$2.00 <br /> <br />$40.00 2 <br />$40.~0 2 <br /> <br />$40.00 2 <br /> <br />$35,00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Eater to~l of fees from Sec. #4 <br /> A2. Add !;% surcharge (.05 x Al ) <br /> <br /> Subtotal <br /> <br /> B. En~r 2~% oflir~Al for Plan Review <br /> (S~c. 3), if required <br /> C, Investigation Fee (if required) <br /> D. Reinspeetion Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ 7~,$'~ <br /> <br />MC 15-34 8/94 R~ceiptNo, <br /> <br /> <br />