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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 /> <br /> Phone 588-5147 $;00 am - 4:30pm <br /> Code-A-Phonic: 588-7904 <br /> FAX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br /> L LOCATION OF INS'TALLATION <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Cross St. <br /> <br />PERMITS ARE NON:FRANSFERABLE AND NON-R. EbRJNDARI.g AND <br />EXPIRE IP WORK IS NOT STARTED WIThU3f 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2B. FOR OWNER INffi'ALLATIONS <br /> <br />3. PLAN REVIEW Sh'X:TION <br /> <br />Wc will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this applicatiom <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when rexluirod by the Oregon Structural <br />Specialty Code, Chapter 53, <br /> <br />MC 15-34 ]1191 <br /> <br />A. Residential Per Uni~ <br /> Servicelncluded: <br /> <br />4. FEE SCHEDULE (Complete and e~ltt~r totaI in A1 Below) <br /> <br />10~ sq. ft. or less $85.00 4 <br />Each a~fional 5(D sq. ft. <br />~ ~ thereof $1 ~,00 <br />L~ni~ed Enemy $20,00 1 <br />Each MarmFd Ilome or M~lu]ar <br />DwelHng Se~ or Feeder _ $40.00 ~ 2 <br /> <br />B. 8ervica~ or FeeOers (Doe~ not ~lcude b~nch circuits, see ~ecd~l D) <br /> <br /> 401 amps to 600 amps <br /> <br /> 201 vanps to 400 amps <br /> 401 ,'unps to 600 amps <br /> Over 600 amps or 1000 volts <br /> <br />a) The fee for ben,Ich clmu~ts ~ <br /> ~ase of semica ('ct ~eeder fee <br /> <br />b) The fee f~ branch cireuts withqm <br /> purchase of ,q~ trice or feeder.~ <br /> <br /> Signal eieeuit(s) or a Ih~ti'~ed energy <br /> <br /> over the allowable th any of the <br /> <br /> (As req~dred by 13t~ilding O~ei¢ial) <br /> <br />5o,oo <br />60,00 2 <br />$100.00 2 <br />$1g0.00 __ 2 <br />$~00,00 __ 2 <br />$40,00 -- 2 <br /> <br />$35.00 ~'I 2 <br />$40.00 ~2 <br />$80.00 ~2 <br /> <br />$35.00 <br />$2,00 <br /> <br />$40,00 ~ 2 <br />$40,00 __2 <br /> <br />$40.00 2 <br /> <br />$85.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Enter total {ff fees from Sec, #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of lineAl for l~lan Review <br /> (Se~, 3? if reqtfirefl <br /> C. h)ve. stigationPe¢ (ff required) <br /> D, Reinspeefion Fee ($25.00) <br /> <br /> TOTAl. AMOUNT DUE <br /> <br /> Receipt No, <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />