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iFOR USE ONLY <br /> OFFICE <br /> Received b~ <br /> Date: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oragon 97301 <br /> <br /> Phone 588-~t47 ~.~0 ams 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: $$a-794S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />p~JlaMH'5 ARE NON-TRANSFERABLE AND NON-REFUNDAB LE AND <br />EXPIRE IF WORK IS NOT STARTED W1THIN 180 DAYS OF ISSUANCE <br />OR I~ WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Electrical Cootra~tor [ Phone <br /> <br />MaLting Address <br /> <br /> FOR OWNER INSTALLATIONS <br />Propeay Owner <br /> <br />Ma L[Lng Address Phone <br />City/State/Zip <br /> <br />Owners Signam¢ <br /> <br />3. PI,AN REVIEW SECTION <br /> <br />Wc will provide plan review service if you complete Section <br />58 and submR two (2) sets of plans and specifications with <br />this application, <br /> <br />This optional plan review program does not suspend the . <br />required submission of lighdng pOwer calculations, planS. <br />and specifications when required by the Oregon SLmcmral <br />Special~ Code. Chapter 53. <br /> <br />MC 15.34 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enlor total itl A I I~low) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> R~,~dentlal <br /> Per <br /> Service Included: Itc~ns CoSt (each) Suml <br /> <br /> 1000 sq, fi. or less ,, $85.00 . <br /> ~aeh additional 500 sq, ft. <br />or zde~ thereof $15.00 <br />Limi~,~t~y $2o.o0 ~-~? <br />l~ac.h Manm'd ~ Modular <br /> D~cli~ eg~,~or ~,,d,r I $40.00 <br /> <br /> 201 amps to 400 <br /> 401 amps to 600 aml~ <br /> <br />a) Thc fee fo~ branch cqrauits <br /> <br />b) !rh¢ f~ for bra~¢h circuts ~u_t <br /> <br /> First brahch circuit <br /> <br /> ( A~ requlr~d by Bailding <br /> <br /> ~50,00 -,, 2 <br /> 60,00 ~2 <br /> <br />$130.00 .. 2 <br />$300,00 _ 2 <br />$40.00 <br /> <br />$35,00 ~2 <br />$4O,00 8 <br />$80.00 2 <br /> <br />$2,00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40,00 <br /> <br />,$35.00 ~ <br /> <br />$50,00 <br /> <br /> FEES <br />A I. E~t~r to{al of ices from S¢¢, J/4 <br />A2. Add 5% ~umhar~e (,05 x Al) <br /> <br /> Subtotal <br /> <br />B. t~nmr 25% of linc A I for Plan R~view <br /> (Sec. 3), if mqukO <br />C. Investigation Fee (if required) <br />D, Reinsp~cfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No, , , <br /> <br />$~_ <br /> <br />$ <br /> <br />$ <br />$ <br /> <br /> <br />