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ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTAL.LA~'ION <br /> <br />MARION COUNT~BUILDING INSPECTION <br /> 220,High Street NE <br /> Salem, O,~gon 9730'1 <br /> <br /> Phoce 588-5147 8:00 a,m, - 4:3o p.m. <br /> Code-A-Phone: 588-7904 <br /> '., FAX: 588-7948 Date: <br /> i Issued by: <br /> <br />SITE #; Permit No. <br /> <br />Directions: <br /> <br />Description: 20 Il. Do irrigation pump <br /> <br />]lenl:er of o~m)&rt¥-' Zacher Fartns <br /> <br />PER/~T~ A"E NON-I~AH3FERABLE ~ID NOI~'-REFUNDhBLE AND E~iU~5 IF I ~W~RD~y~HOT <br /> <br />Contractor <br /> <br />Co~trn~ o['e,License No. <br />i 24-~L3L, <br />Contractor's Board Rog, No. I Job No, <br /> .. t)~2 :) <br /> I <br /> <br />Property Owner <br /> <br />Mailing Add,ess [ Phone <br />City/~tate/ZIp <br /> <br />Tho (nsta[laflon [s be[nO made on property I own which is not Intended for sale. <br />lease or rent, <br /> <br />Owner's Signature <br /> <br />4, FEE SCHEDULE (Complete and enter to~al in A1 below) <br />Number or Inspe,~tlons per permit all~vtat <br /> <br />A. Residential, Single or Items x Coot = Total <br /> <br />MulU-Famlly per d~lllng unit <br />(8en, k~.~uded} <br />1500sq. ft. orle~ -- $ ~, 4 <br />E~h~'l~0~.fl. orpo~en ~ $ 15, . <br />Eaoh Mlg.'d Ho~ or M~ar <br />O~ling ~l~ or <br /> <br />B. ~te~o~ors <br /> <br /> R~n~tOnly $ ~. ~ 2 <br />C, Tem~ra~ ~lce~F~ers <br /> <br /> ~er ~ ~s or 10~ wl~ (S~ 4B) <br /> <br />E. <br /> <br /> ~h s~n or euxine Jigging $ ~. ~ 2 <br /> Sign~ cimuit(s) or a II~t~ enemy <br /> <br /> (Sold on~ <br /> <br />~. ~er <br /> (~ r~i~ <br /> <br />3. PLAN REVIEW 8ECI1ON <br /> Ch~2k appropriate item and enter fee in <br /> <br />__ Connected Load over 200 amps (except single family dwellings) <br />__ Building system over 200 amps (except single fam~ dwellings) <br /> . System over 600 volts <br /> Building over 2 stories <br />_. Building over 10,000 square test <br /> Oc~Jpa~t load over 300 per~ons <br />__ Manufactured Dwelling Park/Recma~n Park <br /> Hazardous Locations <br /> <br />Submit 2 s~s of plans wi'~ any of tee above. <br />TempOrary censtruotlon services do not apply. <br /> <br />At. Enter total of fees from <br />Az Adds%surcharge (.05xAt) <br /> <br /> Subtotal <br /> <br />B, Enter ~'~% of llne Al for Plan Review <br /> (Sec, 3), it required <br />C. Invesflgaliee Fee (if required) <br />D. Reinspeclion Fee ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br />71.00 <br />74~ 55 <br /> <br />$ <br />$.74.5.5 <br /> <br /> <br />