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IFOR QFFiCE USE ONLY ] <br />Received by: <br /> D2te: _ <br /> <br /> ELECTRICAL PERMIT APPLICATION I <br /> Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Stmet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code.A-Phone: 588-7904 <br /> FAX: 588-7948 SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />DesedpUon <br /> <br />PERMITS ARE NON-'iRANSFERABLE AND NON-i~FUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED W1THI~1180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPBN'DBD FOR 150 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Elec~dcal Contractor <br /> <br />Mailing Address <br /> <br /> Owner ] Phone <br />P~op~ny <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />City/StatefZip <br /> <br />The im[allatkm is behlg made On property I own whleh is not Mtended for sale, <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 plans and specifications with <br />this application. <br /> <br /> This optional plan review program does not suspend the <br /> reqal[ed submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 13.34 11/91 <br /> <br />4. IeEE SCHEDULE (Complete nod enter ~otal in A1 below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A, <br /> R~Ment~a! <br /> Per <br /> Unit <br /> / <br /> <br /> m ~m ~of $~.00 <br /> $20,00 <br /> <br /> Dw~ng Se~ m Feede~ $40,~ ~ <br /> <br /> ~ ~ or less $~.00 ~ 2 <br /> ~1 ~ m~amps ~ $10o.oo , <br /> <br /> a) ~e fm for ~anch ~m~ts ~ <br /> pumham ~ ~e~ or fe~er <br /> <br /> ~aeh brach c~muiI $2.00 <br /> b) 'lhe f~ f~ branch ~rcu[s ~ <br /> <br /> Each *i~ or ou~ne lig~g $40,00 ~ <br /> ~e~, alterati~ ~ extmsi~ $40,00 ~ <br /> <br /> a~ve. per rmpec~on $35.00 <br /> Pack of 10 la~s ~ $5.00 ea~ $50.00 <br /> <br /> ( g~ mq~r~d ~ ~uilding OfficiaO <br /> <br />5. FEES <br /> Al. Enter tmal of fees from Sec, #4 $,, <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal $ <br /> <br /> B, Enmr 25% of line A1 for Plan Review <br /> (S~. 3), if teqoired $ <br /> C. Investigation Fee (if mqai~d) $ <br /> D, Re~nspecfion Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $ <br /> <br />Receipt No, <br /> <br /> <br />