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ELECTRICAL PER~T APPLICA'RON <br />Please compste a~ SecOons, 1 ~hrough 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone S88-5347 8:00 a.m,, - 4~0 pm. <br /> Cxx~a,O~-Phone: 588-7904 SITE f~: <br /> FAX: 588-7948 <br /> <br />Issued by: <br /> <br />2A. (33NTRACrO~ I~,~A'I]ON ONLY <br /> <br />Mailing Address ~ / ~ ~ ~ - <br /> <br />Contractor's Board Reg, No ~' - ~ ~ Job NO, <br />........ I <br /> <br />2rt FOROWNERi~TALLATIONS <br />Property Owner <br /> <br />Clty/St~to/Zlp <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> Check appropriate item and enter fee in Section 5B, <br /> <br />~ Connected Load over 200 ~mps (exoept single family dwellings) <br /> <br />~ Building system oVer ~ amps (except single family dwellings) <br /> System over 600 Vel~s <br /> I~uilding over 2 stems <br /> Building over 10.000 square feet <br /> goD, pant load Over 300 persons <br /> Manufactured OweUing Park/Ftecmatton Pa~ <br /> Hazardous Loca~ons <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporal7 consat~--tion servioes do not apply. <br /> <br />4, FEE SCHEDULE (Complete and enter total in At below) <br /> <br />MultI-F~mlly per dwelling unit <br />1500 sq. fl,, o~ Jess <br /> <br /> Each Mfg,'d H~ or Modul~ <br /> Dwelling ~ ot f~r <br /> <br /> R~nn~ Only <br /> <br />C. Tem~ra~ ~lo~F~er~ <br /> <br /> ~er ~ ~s ~ 10~ volts (8~ 4B) <br /> <br /> Ea~ pU~ or Ir~gaaon ~cle <br /> <br /> Signa cimuit(s) er ~ limi~ o~y <br /> <br /> (~ r~ui~ by ~i~ng ~dal) <br /> <br />~$85. <br />__ $15.__ <br /> <br />$,35. <br /> <br />$ 15, <br /> <br />~$36. .,,, 2 <br />__,Sas,, 2 <br /> <br />~$50. <br /> <br />Al,, Enter total of fees from Sec. #4 <br />A~. Add 5% sursharge <br /> <br /> ~ubto~al <br /> <br />B. Enter 25% of line At for PJan P~vi~v <br /> (Sec. 3), if required <br />C. ~ F~ (~ ~l~) <br />D. ~ns~n ~ ($~,,00) <br /> <br /> TOTAL A~UNT OU~ <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />