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[FOR~OFFICE USE ONLY <br /> Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE ~. ~ ~ <br /> Salem, O go. 97S01 Q <br /> ~e 588-51478:~ ~ - 4:3~ ~ <br /> C~e-A-~e:FAX: 588-7~8588-7~4 S[~ ~u ~a ~ mit No. <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through <br /> <br /> I, LOCATION OFIN$~I'ALLATION <br /> <br />PEP~MYFS ARE NON-TKANSFERABLE AND NON.R~FLrN'DAB LB ~ <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR Ih0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prol'e,ly Owner <br />Mailing Address [ Phone <br />City/Smtel'-Z~p <br /> <br />The installation ia behig made on property I own which is not intended for sale, <br />le4t~e, or rent, <br /> <br />PI.AN REVIEW SECTION <br /> <br />We will provide plan review survice if you complete Section <br />512t and submit two (2) sets et' plans and specifications with <br />this npplicatlon. <br /> <br />This optional plan review program docs not suspend the <br />requlmd 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 ll/91 <br /> <br />4. gEE SCHIgDULE (Comptele and enu:t 1,olal in A1 below) <br /> <br /> Null~ber iff lngpc'gtlon~ per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> lJn~t <br /> Service Included: /Icm~ Co~t (each) Sum/ <br /> <br />1000 sq. ft. or less $85.00 __ <br />Bach additional 500 sq. fl, <br />or p~o~ thereof $15.00 <br />1 .imil~il Energy $20.00 -- <br /> <br />r~ach Maimfd florae or Modular <br />Dwelling Setvio_, or Feeder $40.00 <br /> <br /> 200 amps or less <br /> 201 am~ to 400 amFs <br /> 401 amps to 600 amp~ <br /> 601 amps *o I000 amps <br /> <br />Ore,r, 600 amps or lOOO volts <br /> <br />a) The fee for branch cimuits <br /> <br /> ~50.00 <br /> 60.00 <br />$100.00 <br />$150,00 <br />$300.O0 <br />$40.00 <br /> <br />$35.00 <br />Sd0.O0 <br />$~0.00 <br /> <br />$2.00 <br /> <br />$35.00 ..... <br /> $2.00 <br /> <br />$~0.00 <br />$40.00 <br /> <br />$40.00 2 <br /> <br />$35.00 <br /> <br />A1 Enter lotal of fees,l'rorn Sec #4 <br />A21 Add 5~ asarehaego (,05 ~ <br /> <br />B, Enter 25% of line A1 for Plan Review <br /> (S~, 3), if <br />C. lnvestigati~Fee (~mquJred) <br />D. Reinzpecli~ Fee ($25,00) <br /> <br /> 'I~TA L AMOUNT <br /> <br />Receipt No. <br /> <br />$ <br /> <br /> <br />