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FOR OFFICE USE ONLY <br />Received by:. <br />Date: <br /> <br />MARION COUNTY B!-JILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88-5147 8:00 am - 4:30pta <br /> Code-A-Phone: 588-7904 <br /> ~AX, 5s~-w4s SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OFINSTALLATION <br /> <br />Dir~tions <br /> <br />PERMITS ARE NON-TIL~ISF/~RABLE AND NON-REFUNDABLE <br />E~E ~ WO~ IS NOT STATED ~ 180 DAYS OF ISSU~CE <br />OR ~ WOKK IS SUSP~ED FOR lg0 DAYS, <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />ProI~r[y Owner <br /> <br />M~fillng Address Phone <br /> <br />City/State/Zip <br /> <br />'ll~e installation iR being ma& on prol~r~y I own which is not ~tended for sale, <br /> <br />Owner's 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 Structural <br /> Specially Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enter ~oml m A 1 below) <br /> <br /> Number of Inspections p~l' permit allowed <br /> <br />A, <br /> Residential <br /> Per <br /> Unit <br />Service Included: heres Cost (each) Sum <br />1000 aq, ft, or leas $85.00 __ <br />Each addific, ml 500 sq, B, <br />or porti~ C~ereof $1S.00 <br />L/mired Energy ~ $20.00 <br />E~eh Mlmufd ~c/me ar Modular <br />Dwelling SeMce or Fe*der ~ $40.00 <br /> <br />~. Services or Feeders (Does not inlcude branch clreuits, see sect/on D) <br /> <br />InaLaltatlon, Alterations or Relocation / <br />200 amps or <br />201 ~ ~ 4~ <br />~1 ~m~ to 6~ ~ps <br /> <br /> purchase qf ~q~ ~ feeder ~ee, <br /> <br /> .~rcham of ~e~g,,or feeder <br /> <br /> S~nal e~uit(~) or a ~ted <br /> <br /> Pa~ ~ 10 lulls ~ $5.00 <br /> <br /> (As ~q~red by Building Officio <br /> <br /> 50.00 <br /> 8o.oo <br />$100,00 __2 <br />$130,00 <br />$300.00 2 <br />$40.00 2 <br /> <br />$35.00 ~2 <br />$40,00 2 <br />$80,00 <br /> <br />$g6,00 <br /> sz,oo ~ <br /> <br />$40,00 -- 2 <br />$40.00 __ 2 <br /> <br />$40.00 __2 <br /> <br />$35,00 __ <br /> <br />$50.00 <br /> <br />~. I~EES <br /> Al, Enter totalof fees from Sec. <br /> A2. Add 5% surcharge (.05 x A 1 <br /> <br /> Subtotal <br /> <br /> B, !qnter 25%ofllneAl for Plan Review <br /> (See, 3), if rOqulred <br /> C. Inves~igationFee (if required) <br /> D, Reinspcefiofl Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> R~ceipt No, <br /> <br /> <br />