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¥ <br /> <br />FOR OFFICE L~SE ONLY <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Cx)d~-A-Phon~: $88-7904 <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />PERMIr$ ARB NON.TRANSESRASLE AND NON-REFtrND~sLE AND <br />EXPIR£ IF WOILK IS NOT STARTED WTDm~ 180 DAYS OF ISSUANC~ <br />OR IF WORK Lq SUSPI~NDED FOR IS0 DAYS. <br /> <br />2B. FOR OWNER INSTALLATiONS <br /> <br />Propcny Owner <br /> <br />Ma~g Aclth~ss phone <br /> <br />Thc installation is being made on IXogerty I own whleh is not intended for sale. <br /> <br />3. PLAN RE¥1~W SECTION <br /> <br /> I <br /> We wiU provide plan review service if you complet0 Section <br /> 5B and submit two (2) Sets of plans and SlX:Cificafions with <br /> this applicat/on. <br /> <br /> This optional plan review program does not suspond the <br /> required submission of lighting power calculations. :plans, <br /> and specifications when requked by thc Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />FEE SCHEDULE (Corllplat~ and enter total in Al below) <br /> <br />A, R~sldential Per Unit <br /> Service Included: <br /> <br />1000 sq. It. or less <br />Each add~tlotlal 500 sq. It. <br /> <br />Limited Bfle~y <br /> <br />$85.00 .... 4 <br /> <br />$15,00 -- 1 <br />$20.00 <br /> <br />Each Man~lfd Home or Modular <br /> Dw*lli~g Se~J.c~ or Fe,~d~r <br /> <br /> $40.00 <br />Services or Feeders (Does not Lnlcude branch cimuits, see section D) <br /> <br />installation, AlteraOons or Reloeatlon <br /> <br /> 401 amps to 600 amps <br /> 6Ot amps to 1000 amp~ <br /> Owr 1000 amps or volts <br /> <br />201 amps to 400 amps <br />401 amps to 600 amps <br />Over 6~) amps ~ 1000 volts <br /> <br />Ne% Alteration, or E~tenslon Per Panel <br /> <br />a) The fe~ for branch ~feuit~ <br /> <br /> Each brauch cix~uk <br /> <br />b) The f~ f~r branch ~reuts ~thout <br /> <br /> Signal circuit(s) ~t a lh~ted ~aergy <br /> <br /> over the allowable in ~my ~ the <br /> <br /> Pack of 10 labe]~ @ $5.00 <br /> <br />Other <br /> (As requlred by Building Officia0 <br /> <br /> 50.00 _ 2 <br /> ~o.o0 <br />$100,00 -- 2 <br />$130.00 <br />$300,00 2 <br />$40.00 <br /> <br />$35,00 2 <br />$40,00 2 <br />$80,00 2 <br /> <br />$0500 <br /> $2.00 <br /> <br />$40.00 _ 2 <br />$40.00 ~2 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2, Add 5% surcharge (.05 x A 1) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of line Al for Plan Review <br /> (See. 3), if requlxeg <br /> C, I~vcsfigafiongee (ff required) <br /> D, Rcinsp~tica~ Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUg: <br /> <br />$ q77v <br /> <br />$ <br />$ <br /> <br />Receipt <br /> <br /> <br />