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ELECTRICAL PERMIT APFUCA'noN <br />P,~ase o~fl3p,~-e a//,..~/3s. I through <br /> <br />MARION COUNTY BUILDING I,$PEC'FIO,£~ iF ~ <br /> . .220 High Sa'eot NE b~} -' <br /> Salem, On~gon 97301 = ~, <br /> Phone 588~147 8:0o a,m, - 4:30 p,rn, <br /> Code-A-Phone: 588-7~04 SITE #: <br /> <br /> Issued by: <br /> <br />2A. C(3NTRACl'OR BISTAU.ATION ONLY <br /> <br />EleotrJc.~t~ Oontr, ector,_ ' <br /> <br />Supervlsor's License No, <br /> <br /> FOR OWNER INb~'ALLA3~ONS <br />ProPerty Owner <br /> <br />Mailing Acldress I Phone <br /> I <br />city/state/Zip" <br /> <br />The Installetlon Is being made on property I own whioh is not intended for sale, <br />Jeese or rent. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A~ below) <br /> <br />3. PLAN REVIEW SECllON <br /> Check app~ia~ item and an~r fee in Ssclion 5B. <br /> <br />__ Connected Load Over 200 amps (except single family dwellings) <br />__ Building system over 200 amps (except single family dwellings) <br />__ System over 600 voll~, <br /> <br />~ Building over2 stories <br />__ Building ever IO,(X~O square feet <br />__ Occupant load over 300 persons <br />__ Manulactumd Dwelling Par~Recreatldn Park <br />__ Hazardous Locations <br /> <br />Submit ~ sets of plans with any of the above. <br />Temporary consl~ction services do not ap~ly. <br /> <br />A~, Enter tolal of fees from Se~. ~4 <br />A~, Adcl 5% sumharge <br /> <br /> Subtotal' <br /> <br />B. Enter 2~% of line Al for Plan Review <br /> (Se~ 3), if re~uire~ <br />C. Inves~gatJ~3 Fee (if required) <br />D, Reinspec~on Fee ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />