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FOR O~FICE USE 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 /> Code-A-Phone: 588-7904 <br /> FaX: 588-7948 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, i through 5 <br /> <br /> l, LOCA't'tON O~'tNSrAt,Lxt'tO~ <br /> <br /> Iobnddreas 7750 Aumsvklle Hwy. S.E. <br /> I <br /> , ~.~ Cms~ St, <br /> <br /> m~am~ Behlnde 7750 Aumsvflle Hwy on <br /> Ma~res St om right <br /> <br /> D=~ Service Shoo ( Meter loo~ and <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit Ne, <br /> <br />loadcenter~ oounect circuits to loadcem <br /> <br />PEi~VlITS ARE NON-TRANSFERABLE/LND NON-RiiFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED Will.liN 180 DAYS OF ISSUANCE <br />OR il~ WORK I$ SUSPENDED FOR lg0 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br />ElecWiealComactor Jack*s Electri~bone 749-2972 <br />M~sAddrcss 1076tt Mill Creek RD. S.E. <br />p~ayO~.~ Larry Reeser ~Pnoa~ 391_4626 <br />Contractor's l~c=m No. 2 a- 16 C <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Propsrty Owner <br />Mailing Address [ Phone <br />City/State/Zip <br /> <br />The installation is I~Jng made on pro.try I OWn which is not intended for sale. <br /> <br />Owners Signature .... <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We 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 program does not suspend thc <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC15-3411/91 <br /> <br />tel <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />A. R~sidentlal Per Unit <br /> Service Included: <br /> <br />I000 so. ft. or less <br />Each additiotm1500 sq, ~l. <br /> or portion ther*of <br />Limited Energy <br /> <br />$85.00 4 <br /> <br />$15,00 ........ <br />$20.00 I <br /> <br />Each Manufd Home or Modular <br /> Dwelling Service or Feeder <br /> <br /> $40.00 __ 2 <br /> <br />B. Services or Feeders (Docs not hilcude branch circults, sec section D) <br /> Installation, Alterations or Relo~ation <br /> 50.00 ,2 <br /> ~0o a~v,~ o~ l~. ._1__ $ $~o.oo 5 0 <br /> 201 amps to 400 fanps __ 2 <br /> 401 amps ~o 600 amps $100.00 __ 2 <br /> 601amxpsls to 1000 amps $130,00 -- 2 <br /> Over 1000 amps or volts Sg00.00 2 <br /> Reconnect only $40.00 __ 2 <br /> <br />C. Temporary Servlces/Fe~ders <br />Installation, AIt~ation. or Relocation <br />200 amps or less $85,00 __ 2 <br />20I amps to 400 amps $40,00 ..... 2 <br />40I amtpss to 600 amps $80,00 2 <br />Over 600 amps or 1000 volts <br />see "g" above <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch circuits <br /> purchase of sc~ice or feeder fcc <br /> Each branch circuit 14 <br /> b) 'file fee for branch circuts without <br /> purchase of service <br /> <br /> First branch circuit <br /> Each additional branch cJrcult <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each primp or irrigation circle <br /> Each sign or outline llghting <br /> Signal cireuiffs) or a limited energy <br /> panel, alteration or extension <br /> <br />F. Each additional Inspcctlon <br /> over thc allowable in any of the <br /> above, pet inspection <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each <br /> (sold only to electrical contractors) <br /> <br />H, Other <br /> (Aa r~qldred by BuildN, 8 Official) <br /> <br />$2.00 <br /> <br />$35,00 <br /> $2.00 <br /> <br />$40.00 <br />$40,00 --2 <br /> <br />$40.00 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br />.... 5. FEES <br /> A I, Enter total of fees from Sec, #4 <br /> A2. Add 5% sumharge 605 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Sec, 3), if required <br /> C. InvestigatinnFee (if required) <br /> D. Rein~pcctloa Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Reealp; No ...... , ..... <br /> <br />$ 60 OD,, <br /> <br /> <br />