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MARION COUNTY BUILDING INSPECTION <br />220 High Street NE[ <br />'Salem, Oregon 97301 <br /> Phone 588-5147 8.~o a.m. - 4~0 p,m. <br /> Code-A-Phase: 58~7904 SiT[= #: <br /> FAX~ 588~7~48 <br /> Date: <br /> <br />Permit No, <br /> <br />Issued by: <br /> <br />SupervJsor"8 Lloenae NO. <br /> <br />2B, FOR OWNER INSTALLA'nQNs <br /> <br /> Property Owner <br /> <br />' Mailing Add~eS~ <br /> <br />l Job No,, <br /> <br />Phone <br /> <br />City/State/Zip <br /> <br />The installation is bein~'~[nade on prq~erty I own which is not intended for sale, <br />lease or ranL /~ // <br /> Owner's Signature [~ <br /> <br /> '-- (/,J" <br />Check approp~ate item and enmr fee in ~#on SB. <br /> <br /> Connected Load over 200 amps (except single family dwellings) <br />.... Building system over 2O0 amps (except e~gle family dwellings) <br />__ System over SOO volts <br /> Building over 2 stodee <br /> ~uilding over 10,000 square test <br /> , Occupant load over 300 persons <br />__ Manufactured Dwelling Padr~qecmatian Pad( <br /> Hazardous Locations <br /> <br />Submit 2 se~s of plane with any of the above, <br />Temporary coneln,~Jee services do not apply. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br />Number erl* Inspections per permit allowed <br /> <br />,6. Realdantlst,$1ngleor Items x ~st; Total <br /> <br /> Multi-Family per dwelling unit <br /> ($ervi~e included) <br /> 1500 ~1, It er les~ <br /> Each add'l .'SOO sq It. or portion <br /> <br /> B, .~ervlee/Fee~r~ <br /> (10 B~andt Circuit= Includeo7 <br /> InsteJlallon, Aitera~ons ar R~oc~lfon <br /> <br /> 101 ampo tn 400 amps <br /> 401 amps te 600 emps <br /> 60t amps te 1000 emps <br /> Ove~ 1000 amps or volt~ <br /> Reo~nact Only <br /> <br />C. Tempome/Servloes/Feedor$ <br />Ins~Jlalfon, Alteraff~n or Rek~ation <br /> ~00 amp~ or [ess <br /> 201 an~os te 400 an'lpS <br /> 40t amps te 600 emp~ <br /> Over 600 ampo or lIt00 volts (See <br /> <br />D. Branch Clrculta <br />New, Ai~eraEon or EAlenelon Pe~ Panel <br /> One elmuit <br /> Two to ton ~r~JJtS <br /> Each add'l ten circuits or portion <br /> <br />E. MIst~Nleneous <br />(ServiCe or Feeder not included) <br /> Each po n'~o or irrigation cycle <br /> Each elgn or outline lighting <br /> Signal cimuit(e) et a limited energy <br /> panel, alteration et extension <br /> <br />F. Each edd'l Inspoetlan <br /> over tire allowable in any of <br /> {he above, per inSpection <br /> <br />G. Miner Irtstellation Labels <br /> Pack of I 0 labei~s @ $500 each <br /> (Sold any to elac~'l~al conlractors) <br /> <br />H. Ottmr <br /> <br /> (As required by Bulld~hg Official) <br /> <br />__$15. <br /> / sas,, ~'~ <br /> <br />~$80, 2 <br />$130, 2 <br /> <br />~$35, 2 <br />~$40, 2 <br /> <br />~$35, 2 <br /> <br />A~. Enter to~l af fees from Sec, #4 <br />A~ Add 5% ~ (.0~x~ A~ <br /> Subt~teJ <br /> <br />B. Enter 25% of line Al lot Plan Reviow~ <br /> (See, 3), if required <br />CL Investigation Fee (if required) <br />O,, Reinspandon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />