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OPHCE USE ONLY <br />Received by: <br />Date: <br /> <br />ELEC t MiCAL PERMIT APPLICATION <br />P/ease comp/ate a~ ,,~ctbns, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High St. reet NE <br /> ?. Salem. s. Oregon 97301 <br /> Phase 588-5147 8:00 a.m, - 4:30 p.m. <br /> <br />1. LOCR~ON OF INSTALLR'I1ON <br /> <br />Description; <br /> <br />~ ~ I~-~Al.~'l'~l ONlY <br /> <br />2B. FOR OWNER INb'q'ALLA'nON~ <br />Property Owner <br />M~llng Address I Phone <br />C~tylStatolZIp <br /> <br />The Installation is being made on property I own which is not intended for sale. <br /> <br />0wner'~ $ignstum <br /> <br />4. FEE SCHEDULE (Complete a~qd enter total in A~ below) <br /> <br />Multi-Family per dwelling unit <br />(Service included) <br />1500sq. ft. orle~ __ $ 85. __ 4 <br />Eaehadd'lso0SCl, ft. orportton __ $ 15. __ <br />Each Mfg.'d Hoille or Modular <br />Dwelling seneca or feeder $ 35, __ 2 <br /> <br />B, Send, e/Feeders <br />(10 Branch Clrcaits Ir~eded) <br /> <br /> Reconnec~Only __ $ 35, __ 2 <br /> <br /> 201emps m 400 amps __ $ 40. __ 2 <br /> 401ampete600ampe -- $ 80. -- 2 <br /> Over SOO amps or 1000 volts (.~ 4E~) <br /> <br />D, Branch Clmults <br /> <br /> Oneelrcult -- $ 35. -- 2 <br /> Twototertdrc~Jlts , ~ $ SO. ~ 2 <br /> <br />(.~wice ~r Feeder nc; Included) <br />Each pump or Itdgatlen eysle __ $ 36. __ 2 <br />Each sign or outline lighting $ <br />Signal circuit(e) or a limited energy <br /> <br /> over the allowable In any of <br /> <br /> Packofl01abels@$5,0Oeae. h __ $ SO, __ <br /> (Sold eeiy to elac~'ical <br /> <br /> (As raquirad by Building Official) <br /> <br />3. PLAN REVIEW $~ <br /> Check app'opriate Item and enter fee in Sec~on 5B. <br /> <br />__ Connected Load over 200 amps (exeept single family dwetllege) <br />........Building system over 200 amps (except single family dwellings) <br /> System over 600 volts <br />__ Building over 2 stedes <br />__ Building over 10,(X)O square feet <br />__ O~x~pant lead over a00 persons <br />__ Manufactemd D~dlthg Pad~Re~eatlen Pa~k <br /> Hazardous Locations <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary conslruction services do not apply. <br /> <br />A~, Enter telaJ of fees from Sec. ~ $ ,~-'~ <br />A:~. AddS'% sun:hags (.05xA1) $~ <br /> <br /> Subtotal $ <br /> <br />B. Enter 25%oflineA~ for Plan Review <br />(Se~. 3), if required $ <br />C. Invegtigadee Fee (if required) $ , <br />D. Relngpee~on Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $ ~'~.- ~ <br /> <br /> <br />