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MARION COUNTY BUILDING INSPECTION <br />2~0 High Street NE <br /> Salem, Oregon 97301 <br /> Phone 588-5147 <br /> <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete alI Sections, 1 through 5 <br /> <br />$1TI= #: ~ Perm t-HO,, - <br /> <br />I~sued by:: <br /> <br />2B. FOR OWNER ~S'TALLATIONS <br />.... P~O~o~,r owner <br /> <br />City/state/Zip <br /> <br />The lnelallalton is being mede on properly I own whiph is nat Intended for sale <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTIOfl <br /> Check appropriate item and enter fee in Sec~on <br /> <br />_ Connected Load over 200 amps (exoapt tingle family dwellings) <br />__ Building system over 200 amps (except s~gle family dwellings) <br />.. System over 6O0 volts <br /> Building over 2 stories <br />~ Building over 10,000 square feet <br />Occupant load over 300 persons <br />"Manufactured Dwelling Park/Recreation Park, <br />-- Hazan~us Locations <br /> <br />Submit S se~ of plans with any of the above. <br />Temporary con sln~c'lion cervices do not appty,, <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br />Number ~4= InspectiOns per F~rmlt <br /> <br /> ~h MfgJd Ho~ or <br /> <br />~ ~wle~e~ers <br /> <br /> lo0a~ ~ $ ~,,., 2 <br /> 101~ste4~ ~ $ ~. ~ 2 <br /> ~l~ete~ ~ $ ~ 2 <br /> ~la~ 10~ ~ $J30,, ~ 2 <br /> ~ l~0~sor~l~ ~ ~,, ,, 2 <br /> R~nn~ Only $ ~ ~ 2 <br /> <br /> ~00 a~ ~ le~ ~ $ ~ ~ 2 <br /> ~l~s~ ~ $ ~. ~ 2 <br /> <br />D. Branch Ol~ul~ <br /> <br /> ~eoi~lt ~ $ ~,, 2 <br /> T~ ~ ~n dr~i~ ~ $ ~, 2 <br /> ~dlmndmu~sotpof4on ~ $ 15, ~ 2 <br /> <br />(~ ~ F~r nor ~ <br />Each pu~ or Irdg~On ~le $ ~, 2 <br /> ~hs~noroutlinelighang ~ $ ~,, ~ ~ 2 <br /> Sign~ cJmuil(s) o~ a Bmi~ enemy <br /> ~el, al~H~ ~ exertion _ , $ ~, ~ 2 <br /> <br />F, ~¢h nd~l <br /> ~er the ~low~le in any of <br /> <br />G, Minor thsmllnflon <br /> <br /> (~o~ ~ly ~ e~l ~o~) <br /> <br />H. ~er <br /> <br />A~. Enter tetel of fees from See. ~M <br />A~. Adc15%surc~e (.05xA~) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A~ for Plan Review <br /> (Sec,, 3), if mCluired <br />C. Inves~iga~ Fee {if mquirecl) <br />[~. Relnspec~on Fee ($~5,,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br /> <br /> <br />