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iFOIfO. FFICE USE ONLY <br />Received by: <br /> ,, Date: ' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NI~ <br /> Salem, Oxegon 97301 <br /> <br />Phone $SS-5147 8:00 mn - 4:30pm <br />Code-A-Phcn~: 588-7904 <br /> FAX: 588-79~8 <br /> <br />iELECTRICAL PERMIT APPLICATION' I <br />Please complete all Sections, I through 5 <br /> <br />PER/v~TS ARE NON-T~ANSFERABLE AND NON-REFONDAB LE AND <br />]~fP/RE IF WORX IS NOT STARTED ~ 180 DAYS OF/SSUANCE <br />OR IF WORK kS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Electrle~Conwactor ~c~_l ~ o~,~ ~_~ Phone~,. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prol~ny Owngr <br /> <br />Mailing Addmas Phone <br /> <br />City/State/Zip <br /> <br />The imtalhtion is being made on property I c.~vn wE/ch is [~t intended fro- sale, <br /> <br />Ovme~s Signature, <br /> <br />3. PLAN REYtEW SI~CTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5g and submit two (2) se~s of plans and specifications with <br /> this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when reqaired by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />$ITE~/~,, rl Lt - ~j ,5 ~ ) Permit No. <br /> <br />Date: <br /> <br /> · Issued by: <br /> <br />4. PEP SCHEDULE (Complete mad ~ter to~l ~ Al ~low) <br /> <br /> Number of lnsp~tion$ p~ permit allow~ <br /> <br />A, <br /> R~d¢ntlal <br /> Per <br /> Unit <br /> $e~lce In~uded: It.s Cost (caah) <br /> <br />I~ sq. f~ ~ l~ss $85.00 4 <br />Each aa~al 5~ sq, A. <br />~ ~e~of $15.~ <br /> <br /> Dw~g S~ ~ F~e~ $~0,00 ..... <br /> <br />B. Ser~s or Feed~s (D~ not ~lcude bmn~ dw~ts, see secfi~ D) <br /> Ins~latinn~ Al~atlons or R~a~on <br /> <br /> ~I ~ ~ 4~ amps ~ $60.00 <br /> ~1 ~ to6~ a~ps $100.~ <br /> ~1 am~ ~ 1~0 am~ .., $130.~ <br /> ~er 1~ ~ps ~ volta ~ $300.~ <br /> <br />200 amps or loss St-~ $35.00 35 ' 2 <br />201 amps to 400 amps $40.00 -- 2 <br />401 anaps [o 600 auaps ~ $80.00 __ 2 <br />Over 600 amps or 10~0 volts <br /> <br />ourchaa~.of se~ce 9r fqcedet fee <br />b) ~ fe~ for branch cimuts w~t~glt~ <br />Each additional braneAx cimfit $2,00 <br /> <br /> above, per Inspection $SS.00 <br /> <br /> Paak of 10 label* @ $5.00 eaah ...... $$0,00 .... <br /> (sold only to electrical ¢ordraetor,~) <br /> <br />Other <br /> (As reqtdred by tJuildiag Official) <br /> <br /> FEES <br />Al. Enter total of fees £~om Sec. #4 <br />A2. Add 5% su~ha~e (,05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of llne A I for Plan Review <br /> (Sec. $). if required <br />C. Investigation Fee (ff required) <br />D. Reinspecfion Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />MC15-34 11/91 ,,Reeei~ No. <br /> <br /> <br />