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'FO_R. OFFICE USE ONLY <br />Received by: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phc*-~ $$S-$147 8:00 mu - 4~30pm <br /> Codc-A-Ph~: 588-7904 <br /> FAX: 5SS-7¢4S SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION Date: <br />Please complete all Sections, 1 through 5 Issued by: <br /> <br />PermitNo. <br /> <br />PERMITS ARE NON-TI>,ANSFERABLI~ AND NON-REFUNDABLE AND <br />F, XP~I~ IF WORK IS NOT STARTED WI'IIqlN 180 DAYS OF I'SSUANCE <br />OR IF WORK IS SUS?I~NDED FOR 1 $0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Signature of Su~g <br /> <br />2B, FOR OWNER INKrALLATIONS <br /> <br />Property Owner <br /> <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />Th~ installation is being made on property I own wlKch is not inmnded for aale, <br /> <br />[ <br />MC 15-34 I1/91 <br /> <br />pend the <br />ons, plans, <br />Structural <br /> <br />4. FEE SCHEDULE (Complete ~d enter total in A1 I~low) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Item~ Cost (each) Suml <br /> <br />1000 sq. ~ or less $85,00 , , <br />Each addilional 500 sq. ft, <br />or cd~ themof $15,00 <br />Limitc~ncrgy__ $20.00 <br />Each Manufd l~3rnc or Mod01ar <br />Dw~llins Secvic~ or Feeder $40.00 <br /> <br />tL Services or Feeders (Do¢~ not Jaleude branch ei ~¢uits, sec ~eetiog D) <br /> <br /> 201 amps to 4~1 amps <br /> 401 amps to 600 amp~ <br /> OVer 600 amps or I000 volts <br /> <br /> r, atcha~c of scrvice or ~cedcr f¢~ <br /> <br />E, Mt~:ellaneous ($ervke or Feeder Not Included) <br /> Sign~ Ol~it(~) or a lim/lr.A r. uc,~y <br /> <br /> ( A~ r~qulr*d by B~ildlng Off~clal) <br /> <br /> 60,00 <br />61oo.oo <br />$130.00 <br />SaO0.O0 <br />$40.00 <br /> <br />$35.00 _., 2 <br />$40.00 2 <br />$80.00 ...... 2 <br /> <br />$8S.00 <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 />~;, FEES " <br /> Al, Enl~r total of fees from Sec~ #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of 1Lac Al for Plan Review <br /> (Sec. 3), if rexlUlred <br /> C, Inve~fi§ation Fee (ff rcquired) <br /> D, Rcinxpecticm Fcc ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> ,,,Receipt No. ~ , <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />