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IFOR OFFICE USE ONLY <br /> Receivsd by: ' <br /> Date: <br /> <br /> .... <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through <br /> <br /> 1, LOCA~ iON OF IN~ALLATION <br /> <br />MARION COUNTY BUILDING INSI~ <br /> 285 Ch~ch St m - Room 132 <br /> S~, Om~n 97301 <br /> <br /> Permit No. <br /> ~.A-~; 588-*~4 SITE <br /> F~: 588-7~8 ..... ~ .... <br /> Dat~UI[DIN~ INSPVCTJO~4 <br /> <br />p~IkMI~S ARE NON -TEd~NSFERAIgLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN ISa DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR tS0 DAYS, <br /> <br />2/t. FOR OWNER INSTALLATIONS <br /> <br />CiTy/State~ip <br /> <br />The inst~llafion is tming made on prope~y I own which is ~cq inmnded for sal{~, <br /> <br />3. PI,AN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and sat) n t two (2) sets of plans and specdications with <br />this application. <br /> <br /> This optional phm review program does not suspend the <br /> required suhmission of lighting power calculations, plans, <br /> and specifications when required by the Oregon $tructtwal <br /> Sp¢ciahy Code, Chapter 53. <br /> <br />1534 8/94 <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete ~nd enl~r total in A 1 below) <br /> <br /> Per <br /> Unit <br /> / <br /> <br />1000 sq, fl, or lesa <br /> <br /> Installatloll, AReratlon* or Relocation i L~/"I <br /> 200 amps or less <br /> ~SO~O0 ~ <br /> <br />401 amps to 61210 amps <br /> <br />a) The f~c for branch ~ircints afith <br /> <br />b) The fee for branch clrcuts w.~hOut <br /> <br />$35.00 <br />$40.00 <br />SE0.00 <br /> <br />$2.00 ....... <br /> <br />$35.00 <br /> $2,00 <br /> <br />~40,00 <br /> 40.00 <br /> <br />$40.00 2 <br /> <br />$35,00 <br /> <br />$50.00 <br /> <br />5. EES <br /> A 1, Enter total of fees from Soc. #4 <br /> A2, Add 5% surcharge (,05 x A I) <br /> <br /> St~b~otal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Se~. 3), if required <br /> C. Invextigat]c~lFee (if required) <br /> D, Reittspect/.on Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No .... , <br /> <br />$__ <br />$ <br />$ <br /> <br /> <br />