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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERM T APPL CAT ON <br />Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPlfg~SFII~N., .. <br /> ~ '8 ¢.~ . ,. <br /> Salem, Ore on 97301 ~ -¢ <br /> <br /> C~e-A-~e: 588-7~4 ~. ~ ~ I~ <br /> F~: 588-7948 <br /> <br /> Issued by: <br /> <br />1. I,OCATION OFINffI'ALI,ATION <br /> <br />Cro~s St. <br /> <br />De~crytion ~ <br /> <br />PlfRMITS ARE NON.TRANSFERABLE AND NON-REFUNDABLE AND <br />BXI'JJ<IJ iF WORK IS NOT STARTED WlTH~flN 150 DAYS OF ISSUAJq'CE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />Property Owner <br /> <br />Address Phone <br /> <br />City/St ale/Zip <br /> <br />'IEc installation is being made on prol~rty I own which is not intended for sale, <br /> <br />Owners Signature .... <br /> <br />3. PLAN REVIEW SI~SCI'ION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans nnd specifications with <br />this application. <br /> <br />3'his optional plan review prognun does not suspend the <br />reqnired submission of lighting power c',tlculations, plans. <br />and spcci.[ica[/ons when required by thc Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />4, FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br />A. Residelatial Per Unit Number of Inspections per permit allowc,' ~ <br /> <br /> ~ ~m thereof ~ $15.00 <br /> $20.00 <br /> <br /> Dwelling Se~i~ ~ Feeder $40.00 <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> 601 amps m 1000 amps <br /> Ov~r 1000 amps or volts <br /> Reconnect ¢n~ly <br /> <br />C. Temporary Services~'eeder$ <br /> <br /> ptlmhasc of service or ~g~det fee <br /> <br /> Pack of I0 labels @ $5.00 *ach <br /> <br /> ( A~ required by Buildi~$ Official) <br /> <br />SO.O0 ...... 2 <br />~60.00 ,,, 2 <br />$100.00 ...... 2 <br />$130.00 __ 2 <br />$300.00 __ 2 <br />$40,00 2 <br /> <br />$35.00 <br />$40.00 <br />$8000 <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 />5. FEES <br /> Al, Emer total o£ fcc~ from S~c, #4 <br /> A2, Add 5% surcharge (.0S x Al) <br /> <br /> Subtotal <br /> <br /> g. Enter25%ofhneA1 forPlan Review <br /> (Sec, 3), if re~,uired <br /> C. Investigation Fee (if required) <br /> D, Reinspection Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUll <br /> <br />MC 15-34 l]/9l ....... R~c~ipt No, <br /> <br /> <br />