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I~OR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> ';'20 High Stxeet NE <br /> Salem, O~egon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4;30pm <br /> Code-A-Phone: 588-7904 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> i, LOCATION OF INSTALLATION <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />PigRMYI'$ ARE NON-TRANSFERABLE AND NON-P~EFUNDABLI] AND <br />EX!alRE IF WOKK IS NOT STARTED WITHIN 150 DAYS OF ISSUANCE <br />OK iF WORK IS SUSPENDED FOR 1 S0 DAYS. <br /> <br />2A. CONTRACTOR INRTALLATION ONLY <br /> <br />2il. FOR OWNER INSTALLATIONS <br />Prop~r~y Owner <br />M~r~g Add~ess Phone <br />City/Stat&Zip <br /> <br />Thc installation is being made on propex~y I own which is no{ intendod for sale, <br /> <br />Owner', 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 the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Stcuetttval <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 H/91 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A I below) <br /> <br /> Number of Inspections per pcrmi{ allowed ---] <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br /> 1 <br /> Service Included: Iiems Cost (each) Stroll <br /> <br /> 1000 sq, ft or less $85.00 4 <br /> Each additional 500 sq, fl, <br /> or ponlon themof $ ~ S.00 <br /> Limited Energy $~0.00 -- t <br /> <br />l~ach Manufd Home or Modular <br />Dwelling Servic,.* or Feeder $40.00 <br /> <br /> 201 amps [o 400 amps <br /> 401 amps to 600 amps <br /> coO1 am~pls to 1000 amps <br /> <br />C, Temporary Services/Feeders <br /> Inat~Ilatio% AIteraUon, or Relocation <br /> ~00 afflps ct l~$s <br /> 201 amps to d00 amps <br /> 401 ammpa s to 600 amps <br /> Over 600 amps or I000 volts <br /> <br />D. Branch Circuit~ <br /> <br /> a) The fe~ for branch circuits with <br /> puinhan~c 9~ $~c~ or <br /> <br /> Each branch circuit <br /> <br /> b) Th= fcc for branch dircuts without <br /> <br /> First brauch ¢ircult <br /> Each additional branch ¢itc~t <br /> <br />E. Miscellaneous (Service Or Feeder Not <br />Each pump or irrlgatiml diroin <br /> Each sign or outline lighting <br /> Signal cireu{t($) cc a limited <br /> <br />~. Each additional lnspoction <br /> over the allowable hi ally of the <br /> al~v~, per Inspection <br /> <br />G. Minor lns~llation Labels <br /> Pach of I0 labels @ $5.00 =ach <br /> <br />H. Other <br /> ( As required by B~ildin. g Official) <br /> <br />/ SE0,00 <br /> $60,00 2 <br /> $100.00 <br /> $130.00 __ 2 <br /> $300,00 __ 2 <br /> $40,00 __2 <br /> <br /> 85.00 <br />~40.00 <br />$80.00 <br /> <br />$2.00 <br /> <br />$35,00 <br /> sz00 <br /> <br />$40,00 __2 <br />$40,00 --2 <br /> <br />$40,00 2 <br /> <br />$35.00 __ <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Enter tmal of fees fxom Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 2-5% of line A 1 for Plan Review <br /> (Sec. 3), if mqulred <br /> C. lnvestigationFee (j:~ required) <br /> D, F, einspection Fee ($~5,00) <br /> <br /> TOTAl, AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />