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BOR OFFICE USE 'ONLY <br />Received by: <br />Date: <br /> <br />lELECTRICAL PERMIT APPLICATION <br />P/ease complete afl Sections, I through 5 <br /> <br /> LOCATION O~ INSTALLATION <br />~fob Address <br /> <br />I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88-5147 8:00 am - 4:30pm <br /> Co~e-A-~or~: 588-790,1 <br /> FAX: $88-794s SITE #: <br /> I <br /> <br />Description <br /> <br /> NON-TRANSFeRABLE A~ND NON-RI~FUND~BLE AND <br /> ~E <br />~ ~ WO~ ~S NOT ST~ ~ 180 DA~ OF ~$U~C~ <br />OR ~ WOrK ~ SUS~ED FOR 180 DA~. <br /> <br />2A, CONTRA~OR IN~ALLA~ON O~Y i <br /> <br />Mailing Address [ <br />Pt°~tty Owner [Phone f <br /> <br />I~ob No. <br /> <br />$1g~amm of SuI~cvlsing Electr~c~m <br /> <br />23. FOR ow~.a XNSTACL~IONS <br /> <br />Ptol~rty Owner <br /> <br />Ma///ng Address Phone <br />~ty]StatdZip <br /> <br />The Instal~tiotl is l~[n$ made on ptope~ I own wil~eh is ~ [n~nded for sale. <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Sexdon <br />5B and submit two (2) sets of phns and specifications with <br />this application, <br /> <br />This optional plan review program does not su.spend 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 />mc ~5-$4 il~gl <br /> <br />4. FEE SCHEDULE (Complete a~d enter ~l ~ Al ~low) <br /> <br />A. <br /> ~r <br /> ~nit <br /> / <br /> S~1~ Included: I~s Cost (ea~) <br /> <br />or ~ ~of .... $~.00 <br />~d ~e~ $~,00 <br />E~ Manufd ~ ~ M~u~r <br />D~ S~ ~ ~ SaO.O0 <br /> <br /> 201 ~s to 4~0 amps <br /> 401 amps to 600 amps <br /> 601 aml~ to 1000 ~rnl~ <br /> Over I000 ~nps or voks <br /> <br /> 201 anaps to 400 amps <br /> 401 a~ps to 600 amps <br /> Ova, 600 amps ~ I000 v~lts <br /> <br /> b) TI~ fee for br~ch clrcuts wiStout <br /> <br /> Firs[ b:anch ~r~t <br /> Each additional branch drctdt <br /> <br />E. Miscellaneous (Service Oe Feeder Not Included) <br /> F~af.h pump o~ il~iga~ic~ ~c16 ~ <br /> ]~ach sign or ~ttMe lighting <br /> $~gnal ekcuit(a) or a ]imlted energy <br /> <br /> over the allowa~e ~a any of the <br /> alive, ~r In~ <br /> <br /> Pick of I 0 l~bals @ $5.00 eac~ ........ <br /> <br /> ( A~ r~qM~.~d ~y ~Jldlng Off~ci~l) <br /> <br />8. FEES <br /> <br /> A2, Add ~% sumha~ge (.05 x Al) <br /> <br /> B, ]~nter 25% of line A1 for Plan Review <br /> l$ec, 3), if required <br /> C, Investigation Fee (if requital) <br /> D- geth~peefie~ Pee ($25,00) <br /> <br /> TOTAL AMOLrNT DUE <br /> <br /> ~50.00 <br /> ~0.00 <br />$100.00 -- 2 <br />$130.00 __2 <br />$300.00 __ 2 <br />$40.00 __2 <br /> <br />$35,00 2 <br />$40,00 2 <br />$80.00 2 <br /> <br />$2.00 <br /> <br />$2,00 <br /> <br />~4O,00 -- 2 <br />40,00 2 <br /> <br />$40,00 __ 2 <br /> <br />$35,00 <br /> <br />$50.00 __ <br /> <br />$ <br />$ <br /> <br />Reeeil~ No, ,, ,, <br /> <br /> <br />