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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Church SiNE · Room 132 PI::RMIT NO: <br /> Sa]em, OR 97301 <br /> <br /> Dato: <br /> 24 hr. Inspection Line 373-4427 <br /> <br />~, .~, ~ ~ ~ ,: :~! _ Office: Phone 588-5147 8:00am - 4:30pm . ~ _ . <br /> <br /> ELECTRIOAE~aERMIT APPLI~TION /I7..~7~/~ ' <br /> P/ease comp/ego al~ Sections, I through 5 I--' ' x- 4 'FEE $CHI~:)ULB (Complete sod ente~ totalin Al below) <br /> Nmnber of Inspections p~r tmrmit showed ---~ <br /> A. R~ideutlal P~ Unit llar¢~ Cost (each) Sum I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PEP.2vffr$ ^RE NON-TRANSFERABLE ~D <br /> <br /> WO~ IS SUSP~D~ FOR 1 ~ DAYS. <br /> <br />~ CO~CTOR ~ATION O~Y <br /> <br />2B. FOR OWNBR INSTALLATIONS <br />Property Owner <br /> <br />Mailing Addre~ I Phone <br />City/State, Zip <br />Owner'a Signamr~: <br /> <br />3. PLANRIiVIBW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />1000 ~q, fi. or leas $85.00 <br />Each additional 500 sq. ft~ <br /> or portion thereof $15.00 <br />Each Manufactured Home or Modular ~ <br /> <br />B. Serv~ or Feede~l~(l:k~s noi iaclud~ hraach ¢imults~' see sect.ton D) <br /> <br /> 200 amps or less $~0.00 <br /> 201 am~ ,o400 amps $60.~ <br /> <br /> 601 amps to 1000 amps $130.00 <br /> Over 1000 ea~ps or vui~ ~00.00 <br /> <br /> 200 amps or less $35.00 <br /> pjm;h~<~fJ~orvicc of fe~lcr fee <br /> <br /> b) The fao for branch circuits without <br /> purchase of service_or feeder fee <br /> First b~anch <br /> <br />E. Mi~uihmeoas (~vice t~ Fe~de~ Nm ~lud~) <br /> ~¢h si~ or outlino lightMg <br /> <br /> ~er ~e allowablo <br /> <br />O. Min~ In~allation Labels <br /> Pack of 10 l~cls ~ $5,~ ~ch <br /> <br /> (~ required by BuHdi~ <br /> Au~n Dwelli~ Eleetdcal Fe~ <br /> <br />$35.~ <br />$2.~__ <br /> <br />$35.00 -- <br /> <br />$50.00 -- <br /> <br />sq, fl. x $.068 = __ <br /> <br />5. FEES <br /> Al. Enter ~tai of fees from See. ~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter25% of lineAl forPlan Review <br /> (See. 3), ff required <br /> C. Investigation gao (if required) <br /> D. Reinapection Fee ($25.130) <br /> <br /> TOTAL AMOUHT DUE <br /> Receipt No. <br /> <br />MC 15-34 1/96 <br /> <br />$__ <br />$__ <br />$__ <br /> <br /> <br />