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FOR. OFFICE USE ONLY <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION/*:' . . , ~,., ~-, a;c- <br /> <br /> 220 High S~xeet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $$8-5147 S:00 ~-n - 4:30pm <br /> Codc-A-l~or~: 5SS-7904 <br /> FAX: 5SS-794S SITE #: <br /> 1 <br />ELECTRICAL PERMIT APPLICATION Date: <br />Please complete all Sections, 1 through 5 Issued by: <br /> <br />Permit No. <br /> <br /> LOCATION OF INSTALLATION <br /> <br />YobAddr~s$ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON.REFUNDABLI~ AND <br />EXPIRE iF WORK IS NOT S'i3sRTED W1TI-IIN 180 DAYS OF ISSUPdqCE <br />OR IF WORK IS SUSPENDED FOR 1 $0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Elcctfic~l Contractor <br /> <br />]Phone <br /> <br />Mailthg Address <br />PmI:~tly Owner [ Phone <br /> <br />I$~b No. <br /> <br />Phone No, <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />'['he insIalladc~ is t~ing made on prettify I own which is riel intended for sale. <br />PLAN REYIEW 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 />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-$4 11191 <br /> <br />4, FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items Cost (each) Suml <br /> <br /> lOOO sq. fi, or less $85,00 __ <br /> Each additional 500 sq, R, <br /> orgu,~eu thereof $15,00 <br /> Limiiu~l Bnergy __ $20.00 -- <br /> Bm:h M~nu~d Home or Modular <br /> Dwelling Se~Aee or Feeder $40.00 __ <br /> <br />E. Sera4c~'$ or Feeders (Docs not J~l~ude branch circulzs, <br /> Iastallatlo., Alterations or Relo¢alion I <br /> <br /> 201 amps to 400 amps <br /> 401 amps to 600 ampa $100,00 __ <br /> 601 amps to t000 amps $lao.0o __ <br /> Over 1000 *raps or volts $~00.00 <br /> Rem0aueet ~yaly $40.00 __ <br /> <br />C, Temporary Servlce~YFeeders <br /> Ins~llatlon, Alteration, or Relocation <br /> <br /> 201 amp~ to 400 <br /> 401 amp~ to 600 amp~ <br /> Over ~0 arllps or 1000 volts <br /> <br />D. Branch Circuits <br /> <br /> a) The fee for branch c~muils with <br /> uureha~g.of ~c~vlce or ¢~*der fee. <br /> <br /> Bac. h branch cimuit <br /> <br /> b) The fee for branch ckcuts without <br /> <br /> First branch circuit <br /> Each additional branc, h circuit <br /> <br />E, MiscellaneOus (Service or Feeder Not Included) <br /> Bach pump or irrigation circle <br /> Each sign or codine lighting __ , <br /> Signal circult(~) or a llrdi~d energy <br /> <br /> ever the allowable in any of the <br /> abo,,% p~ In s'pe. efion <br /> <br /> Pack of 10 labeh @ $5.00 ~ach <br /> (sold only lo eleclriaal contractom) <br /> <br /> ( As r~quired by Building Official) <br /> <br />$35.00 <br />$40.00 <br />$80.00 <br /> <br />$35,00 <br /> $2.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 __2 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br />5. FEES <br /> Al. Enter total of fees trom Sec. #4 <br /> AY, Add 5% surcharge 605 x A 1) <br /> <br /> Subtotal <br /> <br /> g. Enter Z5% of Uno A1 for Fqan Review <br /> (Sec. 3), if ~e~,u?ed <br /> C, Invc~tlgation Fc.e 0f re~luired) <br /> D, ReinsI~Qon Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />....... Receipt No, <br /> <br /> <br />