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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> pho~ 5s8-5,47 s:oo am-~:3opm qy' <br /> Code-A-Phone: 588-7904 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />Date; <br /> <br />PermRNo. <br /> <br />ioOCATION OF INSTALLATION <br /> <br /> pEILMTI'S ARE NON,.TP. ANS FERABLE AND NON-REFUNDABLE AND <br /> EXPIRE II; WORK IS NOT STARTED WITI tin 180 DAYS OF ISSUANCE <br /> OR IF WORK J.S SUSPENDED FOR 180 DAYS. <br /> <br />2~A.~/~ON'rRAC'FOR INgI'ALLATION ONLY <br /> <br /> Property Owner I Phone <br /> <br />Ztl. FOR OWNER INSTALLATIONS <br /> <br />City/St,xteffS. p <br /> <br />3. i'LAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of phlns and specifications with <br />dfis application. <br /> <br />This optional plan review program does not suspend the <br />requlred submission of lighting pOwer calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Crxte, Chapter 53, <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Oanplete and enter total J~ A 1 I:~low) <br /> <br />1...iS ervlce Included: <br /> <br /> s ft ocles~ $8500 ___ 4 <br /> <br /> or ~m thereof .... $1 $,00 <br /> Limi~d Enemy $20.00 ~ 1 <br /> <br />Each Manufd I-[(anc or Modular <br />Dwelling Set'vice or Feeder $40.00 <br /> <br />B_ Services or Feeders (Does not Mlcude branch circuits, see $¢Clion <br /> l.st~llatlon, Alteratlon~ or Rel~atlon , <br /> <br /> 201 amps ~ 4~ amps <br /> <br /> ~1 am~ to [~ amps $130,O0 <br /> ~or 1~ ~nps or volts $$00,00 <br /> Re~nne~ ~ly ~ Sd0,OO <br /> <br />C, Temporary ServlcedPeed~rs <br /> Installation, AIteratlo~, or RelOeatio~ <br /> <br /> ..~_.~c~a .s ~ of s~wi$~ eT feeder ~ <br /> <br /> ( A~ mqldred by Building Offi¢iaO <br /> <br />$35.00 <br />$40,00 <br />$80.00 <br /> <br />$$$.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 /> ter total of feca from Sec, #4 <br /> d 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of l/ne At for Plan P-.eview <br /> (Sec. 3), if roqu~rcA <br /> C, [nvestisationFee (~ required} <br /> D. Relnspt.~cdon Fee <br /> <br /> ~ TOTAL AMOUNT DUE <br /> <br />$ <br /> <br /> <br />