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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br /> Phone 588-5147 $:00 mm - 4:30pm <br /> C,~le.A-Phrme: 588-7904 <br /> FAX: 588-7948 <br />ELfiGTRIC^L PERMIT ^PPUCATION I <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING EN$~TION '",' <br /> 220 High Street NE % ~ !' ¢0o~ <br /> Salem, Oregon 97301 <br /> <br /> . U(/[ll~ ~ '( Permit No. <br /> <br /> D::,le: <br /> <br />Issued by: <br /> <br />L LOCATIONOFINSTALLATION ~'~[ ~ [l ~ <br /> <br />Dire~tinns <br /> <br />PERMITS AR E NON .TRANSFERABLI~ A/qD NON-P~FUNDABLE AND <br />EXPIRE IF WORK I,S NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK iS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />City/$taie/-/ip <br /> <br />. Phon; <br /> <br />'Die insta/latlon is being made on proper~y I own wl~eh is n~l intended for sal~, <br /> <br />Ow0er'$ Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will p¥ovide plan ~eview 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 /> tequirecl submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specia/ty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A I below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Ualt <br /> / <br /> Service Included: Itcrns Cost (e~ch) Sum/ <br /> <br /> 1000 sq. R, or less -- $85.00 4 <br /> Each addiliona1500 sq. <br /> or portion ~h~reof $15.00 ..... <br /> Limlt~d E~rgy <br /> <br />601 aml~ to I000 amps $130,00 2 <br />Over 1000 amps ~ volts $300.00 2 <br />Recomae~t only $40.00 -- 2 <br /> <br />C. Temporary Set~ices/Feeders <br /> Installation, Alteration, or Relocation <br /> <br /> Ove.r,~ amps or lrO0 vol~S <br /> <br /> b) The fee for branch cirmat$ ~ <br /> <br /> Each pump or irrigation aircle <br /> ~,aeh sign or outline lighthag <br /> <br /> above, per Inspeatinn <br /> <br /> ( As raqMred by ~ltilding Official) <br /> <br />$35.00 <br />$40.00 , 2 <br />$80.00 ...... 2 <br /> <br />SE.00 .... <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40,00 <br />$40,00 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$~0,00 <br /> <br />5. FEES <br /> <br /> Al. <br /> Emer total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x A I ) <br /> <br /> Subtotal $., <br /> <br /> B, Enter 25% of ll)le Al for Plan Review <br /> ($~¢, 3), if mqulred $ ,,, <br /> C, InvestigationFee (ff mquiwd) $__ <br /> D. Reinspe¢fion Fee ($25.00) $ .... <br /> <br /> TOTAL AMOUNT DUE $ <br /> Receipt NO, <br /> <br /> <br />