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FOR OFFICE USE ONLY <br />Received by: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through, <br /> <br />MARION COUNTY BU"ILDING INSPECt.~O_N <br /> <br /> Salem, Oregon 97301 <br /> Phone58S-51473:00*ra-4:30pm~_A_~:S88_7~4 JUL 0 5 <br /> P~: 588-7~S SITE g: <br /> D MARION <br /> <br /> Issued by: .... <br /> <br />L IX)CATION OFINSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUND&BLE AND <br />EYd~I3).E III WORK IS NOT START.ED WITItlN 180 DAYS OFjlSSUANCE <br />OR IF WORK IS SUSPENDIgD FOR 180 DAYS, <br /> <br />gA. CONTRACTOR INffFALLATION ONLY <br /> <br /> I474 - 35th Ave, IV, W'. .... <br /> ' ~'al~'m, Oregon 9730~ , <br />Mailing Address .~.~2.4t [9~ <br /> <br />Property Owaer <br /> <br />NO. ~ <br /> <br />No.i <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />(5lyf Slate/Zip ~ <br /> / <br /> <br />Own¢~Js Signature <br /> <br />3, PLAN REVIEW SEL~I'ION <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 application. <br /> <br />This optional plan review pwgram 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 />4, FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br />10OO sq. B. or l~ss $85,00 _. 4 <br />Each addiliona1500 sq, <br /> <br />200amps orless -- ' I,~60,00 ~ 2 <br />201 amps to 480 amps 2 <br />401 amps to 680 tunps $100.00 ~ 2 <br />601am~m~ to 1OO0 amr~q $130.00 ..... 2 <br /> <br />C. Temporary Servlce~Feed~rs <br /> Inshallatlon, Alteration, or Relocation <br /> 200 amps or less <br /> 201 ~ps to ~ am~ <br /> 401 ~ps to ~0 amps <br /> ~er ~ mpa or I~ vol~ <br /> <br />D. Branch Ci~ulB <br /> New, AIt~ation~ or ~enslon Per Panel <br /> <br /> a) 'lhe f~ f~ ~ch dre~ with <br /> <br /> Pack ~ 10 la~ <br /> <br />~. Other <br /> <br />$35,00 __ 2 <br />$40,00 __ 2 <br />$80,00 __ 2 <br /> <br />$2.00 <br /> <br />$2.00 <br /> <br />$40.00 , 2 <br />$40.00 ........2 <br /> <br />$40.00 2 <br /> <br />$35.00 .... <br /> <br />$~o,oo ~ <br /> <br />A 1, Enter total of fees from Sec. g4 <br />A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 23%of lineAl for l'lanReviow <br /> (Sex:, 3), if required <br />C. ][nv~ig~xti~mFc~ (if requh'~a) <br />D, Reinspecfion Fee ($25,00) <br /> <br /> TOTAl. AMOUNT DUE <br /> <br />MC 15-$4 Il/91 Re~eila'Iq,,. _ <br /> <br /> <br />