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OP"RCE ~ ONLY <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 2L~0 High S~reet NE <br /> ~ Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 a.m, - 4:30 p,m. <br /> <br /> lAX: 588-7o~8 <br /> <br /> ELE[; iHICAL PERMIT APPLJC~TION <br /> P,~ase comp/eta a//Sectbns, i through 5 <br /> <br />1, LOCATION OF INSTAiJLATION <br /> <br />SITE #: Permit No, <br />Date: <br />Issued by: <br /> <br />2B, FOR OWNER I~STALLA1]ON~ <br />Property Owfler <br /> <br />Mailing Address I Phone <br /> I <br /> <br />The installation Is being made on property l own which Is not intended for ~ale, <br /> <br />Owner:a Signature <br /> <br />PL.AN REVIEW S~ <br /> Check appropriate item a~d en~r fee in Section <br /> <br />__ Connected Load over 200 amps (except single femily dwellings) <br />...... Building system over 200 amps (except single family dwellings) <br /> System over 600 volts <br />__ Building over 2 stories <br />__ Building over 10~000 square feet <br />__ Oec~pant load over 300 persons <br />__ Manufactured Dwalling PatlVFlecaea~n Park <br />__ Hazardous Lc]cations <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary construction services do not apply. <br /> <br />4. FEE SCHEDULE (Complete a~d enter total in A1 below) <br />Number of Innpanflons per permit altew~l <br /> <br />A. Realdentlel,$1ngleor Items x Cost = Total <br /> <br />Multi*Family per dwelling unlt <br />( $erv lce !nduded) <br /> 1500 sq. fl,, or lees <br /> Eaoh add1500 SCl, ft. er portion <br /> Eac~h Mfg/d Home or Modular <br /> Dwelling sendce or tastier <br /> <br />B. Servia=e/Feeders <br />ts10 Brar~h GIr~ui~s InClUded) <br />=tallatA3n, Ai~eraffon~ or <br /> 100 aml:~ er leac <br /> 101 amps lo 400 amps <br /> 401 amps te 600 amps <br /> 601 amps to 1000 amps <br /> OVer 1000 amps or volts <br /> Reconnect Only <br /> <br />C, Tempora~ Seralees/Feeders <br />In~tallatlon, Altaraffon et <br /> <br /> 200 amps or less <br /> 20t a~rt:re te 400 aJwl~ <br /> 40~ an'~s to 600 amps <br /> Over ~00 amps or t 000 valts (See <br /> <br />D, $reanh CIroulte <br />New, Altara~on or £xzen~lon Per Panel <br /> One nlraclt <br /> Two Io ton dmuits <br /> Each add'l ten ¢iroults or por~co <br /> <br />E. Ml=collaneou= <br />($en4ce or Feeder not included) <br /> Ea=h pump o~ Irrigation <br /> Each eign or outline Ilgh~ng <br /> Signal clmug(s) or a II~tsd energy <br /> panel, altsretJan or exten,~on <br /> <br />F. Each edd'l lnepectlon <br /> over ~he allowable In any et <br /> the above= per leqoe¢~co <br /> <br />G. Minor Ins~llet~en Labels <br /> Peek et 10 labels @ $500 <br /> (Sold only ~o electocal conffactots) <br /> <br />H. Other <br /> (As requlred by Building Official) <br /> <br />$8s. 4 <br /> <br />__ Sea, __ ~ <br />$130, 2 <br /> <br />$35. <br />__$40.__ <br />$8o, <br /> <br />__ $ ~o,, __ 2 <br />__ $ ~$,, __ 2 <br /> <br />__$35 __ <br />__ $ SO,, __ <br /> <br />Al. Enter te~ of fees from Sec:, #4 <br />A~, Add 5% surcharge (,05 x Al) <br /> <br /> Subtetaf <br /> <br />B, Enter 25% of llne A~ for Plan Review <br /> (Sea. 3), if required <br />C,, Investtgatioe Fee (if required) <br /> <br /> TOTAL AMDUNT DUE <br /> I:~ipt No, <br /> <br /> <br />