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IFOR OFFICE 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:~0 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588.7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />t. LOCATION OP INSTALLATION <br /> <br />PIIRM F['S ARF~ NON.'IRANSFERABLE AND NON-Rt~FUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITH124 lg0 DAYS OF ISSUANCB <br />OR iF WORK IS SUSPP;NDISD FOR 180 DAYS. <br /> <br />ZA, t:ONTRACTOR INSTALLKrlON ONLY <br /> <br />Electricui Contractor C~l;~. <br /> <br />Mailing Addr0ss <br /> <br />Contractor'sIJcenseNo. '~--[~ C <br /> <br />Res. No. -g ~"/.5 ~ lob No, <br /> <br />Phone No, <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />prop~ny Owner <br /> <br />Mailing Addres~ I Phone <br /> <br />City/State/Zip <br /> <br />The installation is being znade on property I own whida ia not intended for aale, <br /> <br />3. PLAN REVIEW SEC~I~ION <br /> <br />We will providc phm review service if you complete Section <br />5B and submit two (2) gets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />rcquirc/.I submission of lighting power calculations, plans, <br />aud specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />4. FEE SCHEDULE (Cmplete =d enmr t~slow> <br /> <br />A. Residential ~r Unit l <br />Service Included: ltcms Cosl (each) Sum/ <br /> <br />10~ ~q. ft. or less $8g,00 ~ 4 <br />Each addifioBal <br /> <br />l.~{ted ~ne~y $20,00 ~ 1 <br /> Dwelling Sc~ or Feeder $40.00 ..... 2 <br /> <br /> Ina~llatlon, Air,efforts or Rel~afion <br /> 201 am~ m 4~ amps $$0.00 ~ 2 <br /> <br /> Each add{fi~laI branch ~rc~t ~ $2.00 <br /> ( As ~q~red by B~ffdlag Offic~0 <br /> <br />AI. Enter total of fees from S0¢. #4 <br />A2. Add 5% ~urchargc (.05 x A I ) <br /> <br />Subtotal <br /> <br />B. Et~ler 25% of line A 1 for Plan Review <br />(Sec. 3), if required $ <br />C. lnvestigationFee (if requ(red) $ <br />D, Rein~pectlon Fee ($25,00) $ <br /> <br /> TOT^L AMOUNT.~UE <br /> <br />MC 15-34 11/91 Receipt No. <br /> <br /> <br />