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MARION COUNTY BUILDING INSPECTION <br />~201~gh S~eet NE <br /> Salem, .~n ~97301 <br /> Phone 588-5147 8,'~ ~.m. - 4:~0 p.m. <br /> Code~q:~rm~: 588-7904 SITE #: <br /> i FAX: ,588-7948 Dats; <br /> <br />2A. C~[RACiuR 1~51'ALL~llON ONLY <br /> <br />Electrical C~tra~tor ~ : ~ ~ <br /> <br />Contractor's License NO,~/_ /~j ~ ~ <br />Conttaotor's 80ar~Reg. No. [ Job NO. <br /> .~ ? ..... <br /> <br />Super~lsor'5 License No.~ ~ ~ Phone~ ~--N°'~ [I ~[ <br /> <br />2B. FO~ OWNER IN~rALLAT)Of~ <br />P(operty Owner <br />~a~llno A~,eS~ I Phone <br /> <br />Check appropriate item and enter fee in Section <br /> <br />Connected Load over 200 amp~ (excep~ sidle family dwellings) <br />Buildi~ sy~.,tem ever 300 amps (ex~ <br /> <br />~il~ng m~ 10,~ ~am f~t <br /> <br />~uf~ ~ing P~n P~ <br />H~us <br /> <br />Submit 2 sets of plans wi~t any of the above. <br />Temporary ¢onsfpJC.§on services do not apply. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Gomplete and enter tut~( in At below) <br />Humber ~f thspe~tlons pm' permit el/owed <br /> <br /> $85. ~,, <br />~$15, <br /> <br /> $35, 2 <br /> <br />~$80. ~ 2 <br />$t30. 2 <br /> <br /> $ 3.5, ~ 2 <br /> <br />~$35. 2 <br />, $ 40. ,, 2 <br />_ SBO.~ 2 <br /> <br />$35.~ 2 <br />S50. 2 <br />$1.5. ., 2 <br /> <br />$36. 2 <br /> <br />A~, Enter tmal of fees from Se~, #4 <br />A~, AddS% surchage (.05xA~) <br /> <br /> Subtotal <br /> <br />B. Enter 25%of lineAr forPlan Review <br /> (Sec. 3), if required <br />O, Inveatigafim Fee (if required) <br />D. Reln ~.~n Fee ($25,o0) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ -~,c~o .,, <br />$ <br /> <br />$, <br />$ <br /> <br />$ ~,¢~.~, <br /> <br /> <br />