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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DI~V'~LOPMENT CENTER <br />285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 $:00 ~n. 4:30pm <br /> Code-A-l~ho~: 588-7904 <br /> FAX: 588.7048 SITE #: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease comp~ere a// Sections, i through 5 <br /> <br />Directions <br /> <br />Description <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REP'UNDABLE AND <br />EXP~E IF WORK I$ NOT STARTED WITHIN 180 DAYS OF ~SUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />,,,] <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prope~.y Owner <br /> <br />C~ty/~;ate/Zip <br /> <br />The installation is being made on property I own wMda is nix inta!lded for sale, <br /> <br />3. PLAN REVIlgW 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 />Speclalty Code, Chapter 53. <br /> <br />MC 15-34 8/94 <br /> <br />Date: <br /> <br />Permit No. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (COmplete and enter total in Al below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Service Included: Ilems Cost (each) <br /> <br />Ea~ ad~l 5~ s~. <br />or~r~ ~emof $15.00 <br /> seo.00 <br />E~h M~d ~e or M~uhr <br /> <br />B. $e~ or Feeders ~s not Mleud~ bm~eh ~re~t~. s~¢ sec~on D) <br /> <br /> 601 amps to 1000 amps <br /> <br />Ove.r. 600 amps or 1000 voks <br /> <br /> I;!grcha~e of service or fee4gLfee <br /> <br />b) The f~ for branch <br /> <br /> Fi~[ branch circuit <br /> Each addi~.onal branch circuit <br /> <br /> Pack of 10 labels @ $5,00 each <br /> <br /> ~$0,00 -..~-----~2 <br /> 60.00 __ 3 <br />$100.00 __ 2 <br />$1an.00 ~2 <br />$000.00 ~ 2 <br />$40.00 ~2 <br /> <br />$35.00 --2 <br />$40.00 --2 <br />$80.00 ......2 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40.00 <br />$40,00 <br /> <br />$40.00 _, 2 <br /> <br />$3S,00 ~ <br />$50.00 <br /> <br />5. FEES <br /> Al, Enter to~al of fees from Sec. #4 <br /> A2. Add 5% ~urcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B~ Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if vequlred <br /> C, Inve~figationFee (ff required) <br /> D. Relnspe. ction Fee ($25.00) <br /> <br /> TOTAL AMOUNT DU Ii <br /> <br /> <br />