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FOR OFFI~/~ USE QNLY ~ <br />Received by: ~ ~ <br />Date: eq~c F <br /> <br /> tAX: 588-7948 <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 ~n - 4:30pm <br /> Coac-A-~one: 585:/~04 SITE #: <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />Di~cdons <br /> <br />PEP, MTf$ ARB NON-TRANSFERABLI~ AiN'D NON-KEFUNDABL~ AiNID <br />F~XPIYt. E iF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK I$ SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />S~gnatu~e of Supervising ~eotfic, lan <br /> <br />SUl:,ez'visor's L~cense No. <br /> <br />2II. FOR OWNER INSTALLATIONS <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) ~ets of plans and specdicafions with <br />this application. <br /> <br />This optional plan review program does not suspend 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 15-34 11/91 <br /> <br />Permit No. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter tot~.l ~ A 1 below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Reeldential <br /> Per <br /> Unit <br /> Se~wice Included: Item~ Cost (each) <br /> <br /> 1000 s . fi- or less $85.00 4 <br /> E~ a~&d~M 5~ ~q, ft. <br /> ~ ~ ~mof $15,00 <br /> ~d E~y $20,00 1 <br /> <br />Each Manor d Home ca Modalax <br />Dweltlng Service or Feeder ~ $40.00 ~ 2 <br /> <br /> Ser~ or Feeders tDocs not J~leude branch cimults, see seclioa D) <br /> <br />Installation, Alterations or Relocation <br /> 200 aml~ or <br /> 201 am~ <br /> <br /> Re--neet ~1~ <br /> <br />a) ~ <br /> nurchase o~..~e~ <br /> <br /> ~er <br /> <br /> Pa~ ~ I0 lulls ~ $5,00 ea~ <br /> <br /> (As ~q~red by Building Officio <br /> <br /> ~0.00 <br /> 0.00 <br />$100.00 <br />$130.00 <br />$800.00 <br />$40.00 <br /> <br />$85.00 ~2 <br />$40.00 .... 2 <br />$80.00 ~ <br /> <br />$2.00 <br /> <br />$ s,oo Teo <br /> Sa.on ~ <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 ~2 <br /> <br />$85.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec, g4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> (Sec, 3), if reo~uired <br /> C. Inve~dgatlc~Fec (ff required) <br /> D. Rclnspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> R=ei No. q27/O <br /> <br />$._cSZ. <br /> <br />Sr <br /> <br /> <br />